STATE OF MAINE APPLICATION FOR INCLUSION ON LIST OF - maine 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the name of the individual or corporation in the designated field. Ensure that this is accurate as it must be a Maine resident or an authorized corporation.
  3. If you are applying as a corporation, provide the contact person's name in the next field. This helps streamline communication.
  4. Fill in the physical address, including street, city, state, and zip code. Remember, this cannot be a P.O. Box.
  5. If your mailing address differs from your physical address, include that information in the provided space.
  6. Complete the telephone number, fax number, and email address fields for further correspondence.
  7. Finally, date and sign the application at the bottom. Make sure to print your name and capacity if applicable.

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Option 1: Apply online through My Maine Connection. Option 2: Download the MaineCare Application and mail it to: Option 3: E-mail an application to Farmington.DHHS@Maine.gov. Option 4: Fax an application to (207) 778-8429. Option 5: Visit one of our district offices and apply in person.
Maximum Monthly Household Income HOUSEHOLD SIZEADULTS (21-64)PREGNANT INDIVIDUALS 1 $1,801 $2,792 2 $2,434 $3,773 3 $3,066 $4,754 4 $3,698 $5,7341 more row
How long will it take to get a decision from DHHS? DHHS is supposed to make a decision about whether or not you can get MaineCare within 45 days of receiving your complete application. If you have not heard from DHHS within 45 days, you should contact them at 1-855-797-4357 and ask about the status of your application.

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Who is eligible for special education? Children with a qualifying disability between ages three and twenty are eligible to receive special education and related services.

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