Maine - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

In Maine, Transitional Assistance Services are officially defined as "Community Transition Services" under the MaineCare Benefits Manual (MBM) Chapter II, Sections 19, 20, and 21. This service provides funding for one-time, non-recurring set-up expenses—such as security deposits, essential furnishings, and utility activation fees—to help individuals transition from an institutional setting (like a nursing facility or ICF/IID) into a community-based home.

The single biggest structural barrier to entry is that Maine does not issue a standalone "Transitional Assistance Provider" license, nor does it allow independent vendors (like moving companies or landlords) to enroll directly as Medicaid providers for this service. Instead, an agency must first be approved by the Department of Health and Human Services (DHHS) Office of Aging and Disability Services (OADS) as a Care Coordination agency or designated Fiscal Intermediary. Only after securing this programmatic approval can the agency enroll via the MaineCare Health PAS Online Portal to administer and bill for transition funds.

1. Service Definition and Scope

Community Transition Services in Maine are designed to eliminate financial barriers for MaineCare members leaving institutional care. The service is governed by the MaineCare Benefits Manual (MBM) under specific Home and Community-Based Services (HCBS) waivers, primarily Sections 19, 20, and 21.

The scope is strictly limited to one-time expenses necessary to establish a basic household. It does not cover ongoing living expenses, and all purchases must be explicitly authorized in the member's Person-Centered Service Plan (PCSP) prior to the transition.

• Covered Expense: Security deposits required to obtain a lease on an apartment or home.
• Covered Expense: Essential household furnishings, including a bed, dining table, chairs, and window coverings.
• Covered Expense: Set-up fees or deposits for utility or service access, including telephone, electricity, and heating.
• Covered Expense: Moving expenses and one-time health/safety assurances, such as pest eradication or initial cleaning.
• Exclusion: Monthly rental or mortgage expenses, food, regular utility charges, and recreational items (e.g., televisions).
• Financial Cap: Expenditures are strictly capped per transition or per lifetime, typically ranging from $1,500 to $2,500 depending on the specific waiver section.

2. Regulatory and Oversight Agencies

The Maine Department of Health and Human Services (DHHS) oversees Community Transition Services through two primary divisions. Programmatic oversight and provider approval are handled by the Office of Aging and Disability Services (OADS), which manages the state's HCBS waivers.

Financial oversight, provider enrollment, and claims processing are managed by the Office of MaineCare Services (OMS) in conjunction with their fiscal agent, Gainwell Technologies, which operates the state's Medicaid Management Information System (MMIS).

• Maine DHHS Office of Aging and Disability Services (OADS): Administers HCBS waivers, approves provider applications, and oversees Care Coordination agencies.
• Maine DHHS Office of MaineCare Services (OMS): Manages the MaineCare program, enforces the MaineCare Benefits Manual, and oversees provider enrollment.
• Gainwell Technologies: The fiscal agent contracted by Maine to operate the Health PAS Online Portal and process MaineCare claims.
• Division of Licensing and Certification (DLC): Oversees the underlying facility and agency licensing for parent organizations, though they do not issue a specific transition service license.

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine does not accept MaineCare enrollment applications for standalone "Transitional Assistance" providers. The absolute structural precondition is that an applicant must first be an OADS-approved Care Coordination agency, Case Management agency, or a contracted Fiscal Intermediary.

Direct service vendors—such as moving companies, furniture stores, or landlords—cannot apply for Medicaid enrollment. They must operate as subcontractors or payees under the umbrella of the enrolled Care Coordination agency, which acts as the pass-through entity for MaineCare billing.

• OADS Provider Approval: Applicants must submit a provider application to OADS and receive an official approval letter before attempting MaineCare enrollment.
• Agency Designation: Must be approved to provide Care Coordination or act as a Fiscal Intermediary under MBM Chapter II, Section 19, 20, or 21.
• Vendor Subcontracting Model: Direct vendors are structurally blocked from enrollment; they must invoice the enrolled Care Coordination agency.
• Service Authorization: Services cannot be initiated or billed unless explicitly authorized in the member's PCSP within the state's Evergreen system.
• NPI Requirement: The enrolling parent agency must possess a Type 2 National Provider Identifier (NPI) tied to their organizational structure.

4. Licensure and Certification Requirements

Because Community Transition Services are administrative and financial in nature, the Maine DHHS Division of Licensing and Certification (DLC) does not issue a distinct license for this service category. Providers are approved via certification rather than facility licensure.

The enrolling agency must hold the appropriate underlying licensure for their primary service type (e.g., a licensed Social Worker agency or Home Health Care Provider) and must pass OADS certification, which reviews the agency's policies, financial controls, and quality assurance plans.

• Agency Licensure: No distinct transition license exists; relies on the agency's primary professional or facility license.
• Business Registration: Must be registered as a legal entity and in good standing with the Maine Secretary of State.
• OADS Certification: Must pass a programmatic review by OADS, demonstrating the capacity to manage and disburse transition funds.
• Insurance Requirements: Must maintain general liability and workers' compensation insurance as mandated by Maine state law.
• HCBS Settings Rule Compliance: Must attest that transition funds will only be used to move members into settings that comply with the federal HCBS Settings Rule.

5. Medicaid Provider Enrollment

Once OADS approval is secured, the agency must enroll as a MaineCare provider through the Health PAS Online Portal. The application must be submitted under the specific waiver sections (e.g., Section 19 or 21) that the agency intends to serve.

The enrollment process requires the submission of the MaineCare Provider Agreement, ownership disclosures, and completion of federal Medicaid screening requirements based on the provider's assigned risk level.

• Enrollment Portal: Applications must be submitted electronically via the MaineCare Health PAS Online Portal.
• Provider Type/Specialty: Must select the HCBS Waiver provider type and specialty codes corresponding to Sections 19, 20, or 21.
• Required Document: The OADS Provider Approval Letter must be uploaded as an attachment to the portal application.
• Required Document: A signed MaineCare Provider Agreement and Electronic Funds Transfer (EFT) authorization.
• Application Fee: Subject to the federal ACA Medicaid application fee (approximately $709 for 2024) unless waived or previously paid to Medicare.
• Revalidation: Providers must revalidate their MaineCare enrollment every five years through the Health PAS portal.

6. Staffing, Training and Background Checks

Staff responsible for coordinating Community Transition Services must meet the qualifications of a Care Coordinator or Case Manager as defined in the MaineCare Benefits Manual. This ensures they have the clinical and administrative background to manage complex transitions.

All personnel must undergo comprehensive background checks through state and federal databases before they can authorize or manage MaineCare funds.

• Staff Qualifications: Care Coordinators typically must hold a valid Maine license (e.g., LSW, LCSW) or a Bachelor's degree in a human services field with one year of relevant experience.
• Background Check: Mandatory fingerprinting and screening through the Maine Background Check Center (MBCC).
• Registry Checks: Must clear the Maine Registry of Certified Nursing Assistants and Direct Care Workers, and the DHHS Adult Protective Services (APS) registry.
• OIG Exclusion: Agencies must conduct monthly screenings of all staff against the federal OIG List of Excluded Individuals/Entities (LEIE).
• Mandatory Training: Staff must complete OADS-mandated training on Person-Centered Planning, the HCBS Settings Rule, and mandated reporting of abuse, neglect, and exploitation.

7. Documentation, Policies and Records

Because transition services involve the disbursement of one-time funds for goods and deposits, MaineCare requires rigorous financial documentation. Providers are strictly audited by OMS and OADS to ensure funds were used appropriately.

Agencies must maintain a dedicated policy manual outlining their financial controls, vendor payment processes, and procedures for retaining original receipts and lease agreements.

• Person-Centered Service Plan (PCSP): The specific transition budget and required items must be documented and approved in the member's PCSP within the Evergreen system.
• Receipts and Invoices: Agencies must retain original receipts, vendor invoices, and canceled checks for all purchased items, deposits, and moving fees.
• Lease Agreements: Copies of the signed residential lease must be kept on file to justify the payment of security deposits.
• Record Retention: MaineCare rules require all financial, programmatic, and clinical records to be retained for a minimum of five years.
• Policy Manual: Must maintain an OADS-approved policy detailing fraud prevention, fund disbursement, and vendor management.

8. Billing, Rates and Claims

Billing for Community Transition Services is executed through the Health PAS Online Portal. Because this is a reimbursement for incurred expenses, claims can only be submitted after the individual has successfully transitioned and the expense is finalized.

Providers use specific HCPCS codes and modifiers dictated by the waiver section. Reimbursement is strictly limited to the authorized amount in the PCSP and cannot exceed the waiver's lifetime or per-transition cap.

• Billing System: Claims are submitted electronically via the Health PAS Online Portal or through EDI 837P batch transactions.
• HCPCS Code: Typically billed using code T2038 (Community Transition, waiver) along with modifiers specific to the waiver (e.g., Section 19 vs. Section 21).
• Prior Authorization: A Prior Authorization (PA) number, generated from the approved PCSP in Evergreen, must be included on every claim.
• Reimbursement Cap: Strict financial caps apply (e.g., $1,500 under Section 19); any costs exceeding the cap are the responsibility of the member, not MaineCare.
• Claim Timing: Claims must be submitted only after the transition is complete and the agency has paid the underlying vendor or landlord.

9. Approval Sequence and Timeline

The pathway to becoming an authorized biller for transition services is sequential. An agency cannot initiate MaineCare enrollment without first securing programmatic approval from OADS.

The entire process, from submitting the initial OADS application to receiving an active MaineCare billing status, typically takes 3 to 5 months, depending on the completeness of the application and state processing volumes.

• Step 1: Submit a provider application, policy manual, and agency credentials to OADS for the specific waiver (Sections 19, 20, or 21). (Timeline: 30-60 days).
• Step 2: Receive the official OADS Provider Approval Letter.
• Step 3: Submit the MaineCare enrollment application via the Health PAS Online Portal, attaching the OADS letter. (Timeline: 45-90 days).
• Step 4: Respond promptly to any Requests for Information (RFIs) from Gainwell Technologies or OMS regarding tax IDs or ownership.
• Step 5: Receive the MaineCare Welcome Letter and activate the trading partner account to begin billing.

10. Common Denials and Survey Findings

Enrollment applications are frequently delayed due to administrative mismatches. The most common issue is a discrepancy between the agency's legal name on the IRS W-9, the NPPES registry, and the MaineCare portal application.

During post-payment audits, OMS frequently recoups funds if the agency cannot produce itemized receipts or if funds were spent on non-covered items like groceries or monthly rent.

• Application Denial: Exact name or punctuation mismatch between the IRS W-9, NPI registry, and the MaineCare application.
• Application Delay: Failure to upload the required OADS Provider Approval Letter during the initial Health PAS portal submission.
• Audit Finding: Missing original receipts, invoices, or canceled checks to substantiate the billed transition expenses.
• Audit Finding: Billing for excluded items, such as monthly rental payments, food, or entertainment items, under the T2038 code.
• Audit Finding: Disbursing funds or billing for transition services before the Prior Authorization was officially approved in the Evergreen system.

11. Key Contacts and Resources

Providers should rely on official Maine DHHS portals and contact centers for accurate guidance. Gainwell Technologies operates the primary call center for all MaineCare enrollment and billing inquiries.

For programmatic questions, waiver application materials, and policy clarifications, providers must contact the Office of Aging and Disability Services (OADS).

• MaineCare Provider Services Call Center: 1-866-690-5585 (Select Option 2 for Enrollment Questions).
• MaineCare Health PAS Online Portal: mainecare.maine.gov (Used for enrollment, revalidation, and claims submission).
• Office of Aging and Disability Services (OADS): Email HCBS.Waiver@maine.gov for waiver application materials and programmatic questions.
• Maine DHHS Division of Licensing and Certification (DLC): (207) 287-9300 for inquiries regarding underlying agency licensure.
• Maine Background Check Center (MBCC): The mandatory state portal for conducting staff background screenings.

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