Members at a Glance
The MaineCare Members at a Glance report summarizes enrollment and claims data to provide key metrics to help define who our members are. The report includes stratifications by member demographic factors like age, gender, county of residence, race and ethnicity.
Download a copy of the report.
- Ensuring Access to Medicaid Services (Access Rule)
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The following data is available in alignment with the Centers for Medicare & Medicaid Services (CMS), “Ensuring Access to Medicaid Services” final rule. The reports linked below focus on the fee for service reimbursement and direct care compensation portions of these requirements.
- Home and Community Based Services (HCBS) Disclosure (PDF)
Average hourly rate of reimbursement for home health aide, homemaker habilitation, and personal care services. - Comparative Payment Rate Analysis (PDF)
A comparison of Maine Medicaid (MaineCare) fee for service payment rates for certain primary care, OB/GYN, and outpatient mental health and substance use disorder services to corresponding Medicare rates.
- Home and Community Based Services (HCBS) Disclosure (PDF)
- Prior Authorization Metrics
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To comply with the CMS Interoperability and Prior Authorization (PA) final rule, MaineCare is required to report aggregated PA metrics on our website annually. Specifically, this includes a list of all medical items and services (excluding drugs) that require PA, as well as data on PA requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Public reporting of these metrics promotes transparency and accountability, helps patients understand PA processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.
- MaineCare Behavioral Health Prior Authorizations Data (PDF)
- MaineCare Prior Authorizations Data (PDF)