MaineCare Customer Service — Practical Guide for Members and Providers

Overview: what “MaineCare customer service” means

MaineCare is Maine’s Medicaid program administered by the Maine Department of Health and Human Services (Maine DHHS). “Customer service” in this context covers a wide set of functions: enrollment and eligibility determination, benefit explanation and authorization, claims and provider relations, member grievance and appeal handling, and assistance with non-emergency services (transportation, care management, and long‑term services). Effective customer service reduces missed appointments, improves medication adherence and prevents unnecessary emergency department use.

As a program funded and regulated by both state and federal law, MaineCare follows federal timeframes and state procedures. For routine applications the federal standard is adjudication within 45 days; disability determinations and complex cases can take up to 90 days. Familiarity with these timelines, and with the supporting documentation required, is central to getting fast, accurate help from MaineCare customer service.

How to contact MaineCare: channels, websites, and what to expect

The authoritative source for all MaineCare customer service contacts and office locations is the Maine Department of Health and Human Services website (https://www.maine.gov/dhhs). MaineDHHS posts up‑to‑date phone numbers, local office addresses, enrollment portals and provider contacts. For benefit applications and renewals the state’s online portal is My Maine Connection (https://www.maine.gov/mymaineconnection/), which supports electronic submission of documents and is the fastest way to initiate or renew coverage.

If you do not have internet access, MaineCare assistance is available by telephone and in person at county DHHS offices. United Way 2‑1‑1 in Maine also provides general help and navigation to benefits and can quickly identify the correct MaineCare contact for your county. Always confirm specific phone numbers and hours on the DHHS website immediately before calling; business hours and phone menus can change seasonally or with policy updates.

Documents and information to have ready (packed, practical list)

• Proof of identity: photo ID or birth certificate for each applicant; Social Security number(s) or proof of non‑eligibility if not issued.
• Proof of Maine residency: lease, utility bill, or official mail with current address—date‑stamped within 30 days.
• Income verification for all household members: two most recent pay stubs, award letters for Social Security/SSI, or a signed employer statement; if unemployed, a benefits denial or unemployment printout.
• Asset documentation where applicable: recent bank statements, vehicle registration, and property tax statements (especially relevant to long‑term care eligibility).
• Medical documentation for disability claims: physician summaries, ADLs (activities of daily living) assessments, medications list, and any prior authorization forms.

Having these items ready at the time of first contact can shorten intake times from weeks to days. When submitting documents electronically through My Maine Connection, scan or photograph documents as PDFs or JPEGs; label files clearly (e.g., “JohnDoe_ProofOfIncome_Mar2025.pdf”). If mailing originals, use certified mail and retain tracking numbers.

Common customer service workflows and expected timelines

New applications: after a complete application is received, expect a decision within 45 calendar days for most Medicaid categories. If the application requires a disability determination (e.g., SSI‑level disability), the process can extend up to 90 days. If the applicant requests expedited processing for a medical necessity, MaineCare has an “expedited” flag—expect a response within 72 hours when the medical provider indicates immediate need.

Renewals and changes: routine renewals are typically processed within 30 days if all requested documentation is provided promptly. Reportable changes (income, address, household composition) should be communicated immediately; failure to report changes timely can lead to retroactive eligibility adjustments or interruption of benefits. For billing and claims, providers should expect adjudication of clean claims within approximately 30 days—if a claim is denied, providers may pursue appeals and must follow the state’s provider dispute resolution process.

Appeals, grievances and escalation — step‑by‑step

MaineCare members have the right to file grievances and request a fair hearing if they disagree with benefit denials, service terminations, or the scope of covered services. Under federal rules, members generally have 90 days from the date of the notice to request an administrative hearing. When a requested service is urgent or life‑threatening, members or providers may request an expedited appeal—these must be adjudicated faster under federal timeliness standards, typically within 72 hours.

Escalation steps that give predictable results: (1) first, contact the MaineCare customer service phone listed on your denial notice and request a written explanation; (2) file a formal grievance via the DHHS grievance process (details on the DHHS website); (3) request a state fair hearing within the 90‑day window; and (4) if unresolved, contact the state Medicaid ombudsman or your legal aid organization for representation. Keep copies of all notices, dates you called, and the names of any representatives you spoke with to establish a documented record for appeals.

Practical tips for members and providers to reduce delays

Use the My Maine Connection online portal for faster processing and to scan/upload documents—paper mail adds 7–14 days on average. When calling customer service, note the reference number for the interaction and request a callback window if wait times are long. If you have limited English proficiency, request interpreter services at the start of the call; DHHS must provide language assistance under federal rules.

Providers should enroll in electronic remittance and claims submission (EDI) and monitor provider portals daily for messages about prior authorizations. Track claim denials by code and appeal within the state’s specified timeframe—prompt appeals dramatically increase the probability of successful resolution. Regularly review DHHS policy bulletins and provider memos posted on https://www.maine.gov/dhhs/ to stay current with benefit changes and billing rules.

What is the maximum income to qualify for MaineCare?

Maximum Monthly Household Income

HOUSEHOLD SIZE	ADULTS (21-64)	PREGNANT INDIVIDUALS
1	$1,801	$2,792
2	$2,434	$3,773
3	$3,066	$4,754
4	$3,698	$5,734

How do I call Medicare customer service?

(800) 633-4227Centers for Medicare & Medicaid Services / Customer service
You can visit Medicare.gov or call the toll-free number 1-800-MEDICARE (1-800-633-4227) or the TTY number 1-877-486-2048 for the latest information about Medicare. What is Medicare?

Is Maine Medicaid the same as MaineCare?

MaineCare is Maine’s Medicaid program. It is funded by the federal and state government. MaineCare provides free or low-cost health insurance and other health benefits to Mainers who meet certain requirements, usually based on income, disability, or age.

How do I check if my Medicaid is active?

The Quick Guide to Checking Your Medicaid Status

1. Visit your state’s Medicaid portal (search “[Your State] Medicaid portal”)
2. Create an account or log in with your Medicaid ID, last name, and date of birth.
3. Steer to “Eligibility” or “Coverage Status” in your dashboard.
4. View your current status (Active, Pending, or Inactive)

How do I speak to Medicaid customer service?

★ Department of Health Care Services

1. California State Contacts.
2. Eligibility.
3. Enrollment.
4. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

How do I contact MaineCare?

MaineCare Member Services
For questions about covered services or to select a Primary Care Provider (PCP) call 1-800-977-6740. TTY users dial 711. You can also email.