Medicaid agency: OMS
MaineCare, administered by the Department of Health and Human Services' Office of MaineCare Services (OMS), delivers most services fee-for-service rather than through managed care organizations; the state runs no Medicaid MCOs, PIHPs, or PAHPs. Most primary care runs through Primary Care 2.0, a statewide per-member-per-month case-management arrangement that grew out of the state's longstanding Primary Care Case Management (PCCM) program; practices willing to take on shared-savings risk can join an Accountable Communities tier within the same program. Behavioral health and non-emergency medical transportation are carved out to dedicated administrators; long-term services and supports and everything else are billed fee-for-service directly. A Section 1115 demonstration, in continuous operation since 2002, extends coverage to a defined group of Mainers with HIV or AIDS who would not otherwise qualify for MaineCare. Maine has no PACE program. The state also received CMS approval in December 2018 for a separate Section 1115 work-requirements demonstration, but the incoming Mills administration declined to implement it after taking office the following month, and the waiver was formally withdrawn before its 2023 expiration.
MaineCare runs no managed care organizations. Primary care runs instead through Primary Care 2.0, a fee-for-service arrangement that pays participating practices a per-member-per-month care-coordination fee and authorizes referrals, continuing the role Maine's Primary Care Case Management (PCCM) program has played since 1999. An Accountable Communities tier within Primary Care 2.0 lets networks willing to take on shared-savings risk move beyond the base per-member-per-month payment. LD 1334, a 2023 bill that would have required most MaineCare members to enroll in managed care, with implementation beginning July 2025 and completing by July 2027, received a public hearing but did not advance out of committee; the Department testified that the bill's proposed timeline was not achievable given the scope of the transition.
Long-term services and supports are delivered fee-for-service through five active Section 1915(c) HCBS waivers, each serving a distinct population: the Elderly and Adults with Disabilities Waiver, the Home and Community Based Services Waiver for Adults with Other Related Conditions, the Home and Community Based Services Waiver for Members with Brain Injury, the Home and Community Services Waiver for Adults with Intellectual Disabilities or Autism Spectrum Disorder, and the Support Services Waiver for Adults with Intellectual Disabilities or Autism Spectrum Disorder. A separate Section 96 State Plan personal-care option pays agencies per member per minute for in-home nursing and care-coordination services outside the waiver structure. Two other Section 1915(c) waivers (the Consumer Directed Personal Assistance Services Waiver and the Services for Children with Intellectual Disabilities and/or Pervasive Developmental Disorders Waiver) have concluded and are no longer active. DHHS has proposed, but not yet received CMS approval for, a new Home and Community Based Services Across the Lifespan Waiver serving individuals 14 and older with intellectual disabilities or autism spectrum disorder, submitted alongside a companion Section 1915(b)(4) selective-contracting waiver for Community Resource Coordination, intended to coordinate case management for that same population.
Not integrated into managed care
Behavioral health is carved out from the fee-for-service general benefit and administered statewide by Acentra Health, which has reviewed and approved MaineCare-funded mental health and substance use services since 2007. A separate Section 1115 Substance Use Disorder Care Initiative, approved in December 2020, lifted the federal IMD exclusion so MaineCare can pay for residential substance use disorder treatment in facilities larger than 16 beds; its current authorization runs through December 31, 2026, with a renewal already under CMS review.
Carved out
Dental is a direct fee-for-service benefit, billed under MaineCare Benefits Manual Section 25; Maine does not contract with a separate dental benefit administrator.
Modivcare is MaineCare's designated statewide non-emergency medical transportation broker, though the transition away from Maine's prior regional brokers is still under way. Modivcare directly serves Regions 1, 2, 6, 7, and 8, and also serves Region 5 through a partnership with Waldo Community Action Partners, which operates that region's brokerage as MidCoast Connector. Penquis continues to broker rides in Regions 3 and 4, with a full transition to statewide Modivcare coverage expected by January 1, 2027.
Gainwell Technologies operates MIHMS, Maine's Medicaid Management Information System, and is rolling out an upgraded MaineCare Partner Portal expected to launch in mid-October 2026. Mercer Health & Benefits LLC holds Maine's actuarial and rate-certification services contract, which includes independent rate certification for the non-emergency medical transportation program.
358 agency updates tracked for Maine. Available with Pro.
See them with ProMaine Morning Star reports that Republican Paul LePage and Democrat Matt Dunlap clashed in their first debate for Maine's open 2nd Congressional District seat, sparring over healthcare policy including Medicaid. Dunlap backed restoring expired ACA marketplace premium subsidies, which 85% of Maine's 61,000 CoverME.gov enrollees relied on, and voiced long-term support for universal healthcare; LePage opposed Medicaid expansion and defended federal Medicaid cuts, citing a $50 billion rural health funding program as an offset. LePage also repeated claims of widespread Medicaid fraud in Maine, though the state's most recent federal payment error rate was 2.4%, below the 3.2% national average, with only about 0.1% of spending confirmed incorrect. The debate occurred Oct. 1, ahead of the election to replace outgoing Rep. Jared Golden.
More than 1,000 immigrants in Maine lost MaineCare coverage starting October 1 under eligibility changes from the 2025 federal budget law (H.R. 1), which excludes refugees, asylum seekers, trafficking and abuse victims, and noncitizen veterans from Medicaid. Children under 21, pregnant people, and green card holders are unaffected. Maine DHHS has notified affected households since June, and state officials say many losing coverage are high-needs individuals with disproportionate use of home and community-based services and high rates of serious mental illness. Unlike California, New York, and Pennsylvania, Maine has no state-funded backstop program to cover the gap, though a $250 million legislative proposal to offset federal cuts failed to pass last session.
The Senate Majority PAC, a Democratic super PAC, launched an ad campaign attacking Sen. Susan Collins (R-Maine) over the closure of about a dozen birthing centers in Maine, linking the closures to Medicaid cuts in the One Big Beautiful Bill Act. The ad argues Collins enabled the cuts despite voting against the final legislation. The campaign is part of ongoing 2026 midterm messaging tying federal Medicaid reductions to state-level provider closures, particularly in maternal health services. No new policy or funding action is described; this is a political advertising campaign referencing prior Medicaid legislation.
A Maine Center for Economic Policy analysis attributes rising household costs to federal policy changes, including the January 2026 expiration of enhanced Affordable Care Act premium tax credits for marketplace plans. Healthcare costs represent the largest driver, with families enrolled in marketplace plans seeing significant premium increases while those with employer coverage were less affected. Maine's individual market premiums rose 14.8% for 2027, reflecting declining enrollment by healthier members after subsidies expired. The analysis also cited rising gas, heating oil, and tariff-related costs, but healthcare policy changes had the most direct impact on affected households.
Maine's Department of Health and Human Services held a public hearing on September 10, 2026, to discuss proposed stricter oversight of MaineCare (Medicaid) providers. More than a dozen legislators and members of the public testified in support of enhanced oversight. Providers and advocates acknowledged the need to address intentional wrongdoing but raised concerns about patient privacy implications under the proposed measures. The hearing reflects ongoing debate about balancing program integrity with privacy protections in Maine's Medicaid program.
13 active waivers tracked for Maine. Available with Pro.
See them with Pro6 active solicitations tracked for Maine. Available with Pro.
See them with Pro6 managed care contracts tracked for Maine. Available with Pro.
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