Traumatic Brain Injury Benefits in Maine

To qualify for most federal disability benefits, you must have a severe physical or mental condition (like a Traumatic Brain Injury) that is expected to last at least 12 months or result in death, and prevents you from working. For SSI, you must also meet strict income and asset limits. SSDI is based on work history and disability.

In Maine, adults with a Traumatic Brain Injury may qualify for MaineCare if they meet the disability criteria of the Social Security Administration (SSA) and have income below 100% of the Federal Poverty Level (FPL): $1,215/month for an individual or $1,644/month for a couple in 2023[1]. Asset limits are $2,000 for an individual or $3,000 for a couple[1][2]. If you work despite your disability, you may qualify with higher income—up to 250% of FPL for certain groups—with an asset limit of $8,000 (individual) or $12,000 (couple)[2]. SSI recipients are automatically eligible for MaineCare[1]. For long-term care or HCBS waivers, you must also show a medical need for nursing facility level care, even if you want to stay at home[4]. If you are over the limits, a Medically Needy deductible may still allow you to get coverage by spending down your income on medical bills[6]. MaineCare uses a 60-month look-back period to review asset transfers for HCBS waiver applicants[4].

Get started with Maine disability benefits in three steps: 1) Gather proof of income, assets, medical records, and disability status. 2) Apply for SSI/SSDI if you haven’t already. 3) Apply for MaineCare online at MyMaineConnection.gov or contact your local Office of Family Independence for help—applications are processed quickly for SSI recipients[6].

• Step 1: Confirm your disability status. A Traumatic Brain Injury must meet SSA disability standards. If you already receive SSI or SSDI, you likely meet this requirement[1]. If not, you can submit a MaineCare Disability Determination request for review[1].
• Step 2: Prepare documents. You’ll need proof of identity, residency, income, assets, and medical documentation showing your TBI diagnosis and impact on daily life[6].
• Step 3: Apply for MaineCare. Submit your application online at MyMaineConnection.gov or visit a local Office of Family Independence. If you receive SSI, your application will be fast-tracked[6].
• Step 4: Apply for HCBS waivers (if needed). If you need long-term supports to live at home, ask about Home and Community-Based Services waivers. You will need a medical assessment proving you require nursing facility level care[4][6].
• Step 5: Follow up. Check the status of your application regularly and respond quickly to any requests for more information. If denied, you can appeal.
• Step 6: Consider consulting a benefits counselor. Free help is available from Consumers for Affordable Health Care by calling (800) 965-7476[3].

• Supplemental Security Income (SSI): Provides monthly cash assistance for low-income individuals with disabilities, based on financial need and disability status. SSI recipients in Maine are automatically eligible for MaineCare[1].
• Social Security Disability Insurance (SSDI): Offers monthly payments based on your work history and tax contributions. SSDI does not have strict asset limits, but does require a qualifying work record and disability.
• Medicare: Available to most SSDI recipients after a 24-month waiting period, and covers hospital, medical, and prescription drug benefits.
• ABLE Accounts: A savings account for people with disabilities that does not count against SSI or SSDI asset limits.

• MaineCare (Medicaid): Covers doctor visits, hospital care, prescription drugs, mental health, substance use disorder treatment, and—for those who qualify—long-term care and Home and Community-Based Services (HCBS) waivers[3][6]. There is a special eligibility group for people with disabilities who are working, with higher income and asset limits[1][2].
• Home and Community-Based Services (HCBS) Waivers: Help people with Traumatic Brain Injury stay at home by covering services like personal care, home modifications, and respite care. These programs have limited slots and require both financial and medical eligibility[4][6].
• Medically Needy Program: If your income or assets are over the usual limits, you may qualify for MaineCare by meeting a deductible based on your medical expenses[6].
• Newborn Coverage: There is no income test for newborns for the first year of life[1].
• Long-Term Care Coverage: For those who require nursing facility level of care, MaineCare can pay for nursing home stays or HCBS as an alternative[4][5].

Maine residents with Traumatic Brain Injury may open an ABLE account to save for disability-related expenses without affecting eligibility for SSI, SSDI, or MaineCare. Funds in an ABLE account (up to $100,000) do not count toward asset limits for these programs.

MaineCare income limits for people with disabilities are generally 100% of the Federal Poverty Level (FPL): $1,215/month (individual) or $1,644/month (couple) in 2023[1]. The "working disabled" group allows income up to 250% of FPL: $3,038/month (individual) or $4,109/month (couple), with a premium up to $20/month[1][2]. Asset limits are $2,000 (individual) or $3,000 (couple) for standard eligibility, and $8,000 (individual) or $12,000 (couple) for the working disabled group[1][2].

If you receive too much in benefits, you may have to repay the overpayment. Always report changes in income, assets, living situation, or health status right away to avoid overpayments and potential penalties. For help, see our guide on avoiding overpayments.

• Maine Office of Family Independence
  Phone: 207-624-4100

  Website

  Handles MaineCare applications and eligibility questions
• Consumers for Affordable Health Care
  Phone: 1-800-965-7476

  Website

  Free benefits counseling and application assistance
• Social Security Administration
  Phone: 1-800-772-1213

  TTY: 1-800-325-0778

  Website

  Handles SSI and SSDI applications

• What is MaineCare and who is eligible?

  MaineCare is Maine’s Medicaid program. People with a disability like TBI may qualify if their income and assets are below state limits, or if they receive SSI. Some working people with disabilities can qualify with higher incomes[1][3][6].

• How do I apply for MaineCare with a Traumatic Brain Injury?

  Apply online at MyMaineConnection.gov or visit your local Office of Family Independence. Gather proof of income, assets, residency, and medical documentation about your TBI. SSI recipients are automatically eligible[1][6].

• What if my income is too high for MaineCare?

  You may still qualify by using the Medically Needy program, which lets you subtract medical expenses from your income to meet eligibility. A MaineCare representative can explain how this works[6].

• Are there services to help me stay at home instead of moving to a nursing facility?

  Yes, Home and Community-Based Services (HCBS) waivers provide support like personal care, home modifications, and respite care. These programs have limited slots and require both financial and medical eligibility[4][6].

• Can my family get MaineCare if I have a TBI?

  Yes, family members may qualify for MaineCare based on their own income and situation. Each person in the household is evaluated separately. Children under 18 may have higher income limits than adults[3][6].

• Does MaineCare cover mental health and therapy for TBI?

  Yes, MaineCare covers mental health services, therapy, and behavioral health supports that are medically necessary for a Traumatic Brain Injury[3].