Maine Medicaid waiver guide
Learn how Maine Medicaid waiver services work, which state agency to start with, how the application process usually begins, and where to search for home and community-based services.
Last reviewed July 2026. See something out of date? Use the “Suggest an edit” button to let us know.
Maine serves adults with intellectual disabilities and autism through two MaineCare waivers, known by their rule sections: Section 21, the comprehensive program, and Section 29, a support services package. The Office of Aging and Disability Services (OADS) runs both. One rule shapes everything: you can only be enrolled in one waiver at a time. Maine is also developing a third option — the HCBS Lifespan Waiver — aimed squarely at youth transitioning to adulthood and at people currently sitting on the Section 21 and 29 waitlists.
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Adults with intellectual disabilities or autism who need comprehensive supports, including residential
Adults who need a more limited support package while living in their own or family home
Initially youth ages 14–17 and adults not already enrolled in Section 21 or 29 — pending CMS approval
You must be enrolled in MaineCare, meeting financial requirements determined by the Office of Family Independence, and be found medically eligible. For intellectual disability, eligibility rests on functional deficits that manifested before age 22 and are directly related to identified intellectual impairment; autism spectrum disorder has its own criteria. Medical eligibility is established through an application packet containing a comprehensive evaluation by a licensed physician, clinical psychologist, or psychological examiner, an adaptive behavior scale test, and a general intelligence test or comparable measure.
You must be enrolled in MaineCare. Financial eligibility is determined by the Office of Family Independence, separately from the medical eligibility OADS assesses.
For intellectual disability, functional deficits must have manifested before age 22 and be directly related to identified intellectual impairment. Autism spectrum disorder is assessed on its own criteria.
Medical eligibility requires a comprehensive evaluation by a licensed physician, clinical psychologist, or psychological examiner; an adaptive behavior scale test; and a general intelligence test or comparable measure. A packet missing any of the three is not complete.
You cannot be enrolled in Section 21 and Section 29 simultaneously. Which one you pursue is a real choice, not a formality.
Both waivers have waitlists, and because you can only be enrolled in one at a time, which list you are on matters. Section 21 is the comprehensive program; Section 29 is a lighter package. Your case manager can check your waiver application, your waitlist status, and your waiver status — three distinct things that are easy to confuse.
Waiver services are paid through MaineCare, so financial eligibility through the Office of Family Independence comes first.
Open linkYou need all three pieces: a comprehensive evaluation by a licensed physician, clinical psychologist, or psychological examiner; an adaptive behavior scale test; and a general intelligence test or comparable test. Missing one stalls everything, and the ten-day clock does not start.
Open linkOnce OADS has a complete packet, an intake coordinator contacts you within ten days to schedule an intake assessment. If that window passes, follow up — it usually means something was missing.
You can only be on one waiver at a time. Section 21 is comprehensive, including residential support; Section 29 is a lighter package for people living at home. Talk this through with your case manager rather than defaulting to whichever comes up first.
Maine is developing an HCBS Lifespan Waiver, pending CMS approval, with initial enrollment aimed at youth 14–17 and adults not already on Section 21 or 29. The state is specifically encouraging people already on the Section 21 and 29 waitlists, and families of youth 14–21, to engage. Questions go to OADS.LifespanProject@maine.gov.
Open linkExact covered services depend on the waiver, assessed need, Medicaid rules, funding, and state program requirements. Confirm services, availability, and payment acceptance with the state, support coordinator, and provider.
Maine offers self-directed options within its waiver services, letting participants and families take a role in hiring and directing their own support staff rather than relying only on agency providers. Ask your case manager which services can be self-directed under Section 21 or Section 29.
Approved waiver services are paid by MaineCare. Once enrolled, there is generally little or no direct cost for covered services.
Section 21 is the comprehensive package including residential support; Section 29 is lighter and oriented toward people living at home. Because you can only hold one at a time, choosing the smaller package to get served sooner has consequences worth thinking through.
The Office of Family Independence determines MaineCare financial eligibility, while OADS determines medical eligibility. The two run on their own tracks and can stall independently.
Maine's Child Development Services system provides early intervention and preschool special education, separately from the adult waivers.
School districts provide special education under an IEP. Keep every evaluation — Maine's medical eligibility rests on cognitive and adaptive testing, and school records are often the best source.
This is where Maine is actively building. The HCBS Lifespan Waiver targets youth ages 14–17 initially and is designed to strengthen transition and in-home services for youth moving into adulthood. Families in this age band should engage with the project now rather than waiting for adult services to begin.
Learn moreFunctional deficits must be documented as manifesting before age 22. Make sure the evaluations establishing that exist before the deadline passes.
If MaineCare eligibility, medical eligibility, or a waiver service is denied, reduced, or ended, you have the right to appeal and to request a hearing within the deadline printed on your notice. Disability Rights Maine is the state's protection and advocacy agency and takes requests through an online intake form.
Protection & Advocacy agency for Maine
1-800-452-1948Visit siteMaine's DD agency — waiver applications and eligibility
Visit siteEmail HCBS.Waiver@maine.gov for application materials if you have no case manager
Visit siteThe waiver in development — questions to OADS.LifespanProject@maine.gov
Visit siteFree advocacy — 800-452-1948 (V/TTY), 207-626-2774 locally, video phone 207-766-7111
1-800-452-1948Visit siteLocal help & referrals — dial 211
Visit siteNo. You can only be enrolled in one waiver at a time. Section 21 is the comprehensive program including residential support; Section 29 is a lighter package for people living at home. Because it is either/or, the choice deserves a real conversation with your case manager.
Three things: a comprehensive evaluation by a licensed physician, clinical psychologist, or psychological examiner; an adaptive behavior scale test; and a general intelligence test or comparable test. If any piece is missing the packet is not complete, and the ten-day intake clock never starts.
Once OADS receives a complete application packet, an intake coordinator contacts you within ten days to schedule an intake assessment. If more than ten days pass in silence, call to check whether the packet was actually complete.
It is a new HCBS option Maine is developing, pending CMS approval, focused on flexibility across life stages and on youth moving into adulthood. Initial enrollment targets youth ages 14–17 and adults not already enrolled in Section 21 or 29 — and the state is specifically encouraging people already on those waitlists to engage. If either describes you, contact OADS.LifespanProject@maine.gov.
Email HCBS.Waiver@maine.gov to request application materials and guidance, or start with the OADS Intake and Eligibility page. A case manager can help with both the MaineCare application and the waiver application once you have one.
You must be enrolled in MaineCare, meeting financial requirements determined by the Office of Family Independence, and be found medically eligible. For intellectual disability, eligibility rests on functional deficits that manifested before age 22 and are directly related to identified intellectual impairment; autism spectrum disorder has its own criteria. Medical eligibility is established through an application packet containing a comprehensive evaluation by a licensed physician, clinical psychologist, or psychological examiner, an adaptive behavior scale test, and a general intelligence test or comparable measure.
apply for mainecare, assemble the complete application packet, wait for the intake coordinator, choose between section 21 and section 29, then enroll and choose providers. Start with Maine Office of Aging and Disability Services.
Covered services vary by waiver and assessed need, and commonly include in-home supports, respite, supported employment, day services, behavior support, residential supports. Confirm specifics with the state and provider.
Both waivers have waitlists, and because you can only be enrolled in one at a time, which list you are on matters. Section 21 is the comprehensive program; Section 29 is a lighter package. Your case manager can check your waiver application, your waitlist status, and your waiver status — three distinct things that are easy to confuse.
Approved waiver services are generally covered by Medicaid at little or no direct cost once enrolled, though some enrollees may owe a monthly patient responsibility based on income.
What each waiver covers, the one-waiver-at-a-time rule, and how to request application materials.
MaineThe application packet requirements and what happens after you submit.
MaineMaine's waiver in development, its focus on youth transition, and how to get involved.
MaineFree protection and advocacy services, including appeals help.
MaineFind waiver providers and services in Maine on Waiverly.
Looking for another state? Browse the full resource map