Maine

Quick Facts

Key Provisions

• A direct care agreement is legally defined as a contract where a provider agrees to offer primary care services for a set periodic fee, agrees not to bill third parties on a fee-for-service basis, and ensures any per-visit charges are less than the monthly fee equivalent (22 M.R.S. § 1772).
• Direct care membership agreements are explicitly declared not to be insurance and are therefore not subject to regulation by the Maine Bureau of Insurance. This is the cornerstone of the state's DPC legislation, providing legal clarity and reducing regulatory overhead for practices.
• Legislation passed in 2025 expanded the original DPC law to cover "direct health care service agreements" (DHCSAs). This broadens the provider scope to include all licensed physicians and other advanced health care practitioners who are authorized for independent practice in the state.
• Health insurance carriers are prohibited from denying payment for otherwise covered services (like specialist care or labs) or imposing additional cost-sharing on a patient solely because the referral came from an out-of-network direct care provider (24-A M.R.S. § 4303(22)).
• To facilitate referral protections, an insurance carrier may require a patient to provide a written attestation or a copy of their direct care agreement to verify the provider-patient relationship when processing claims for referred services.
• Physicians and other medical professionals are permitted to accept direct payment from Medicare or Medicaid beneficiaries for services and medical products. This is contingent upon the provider having formally opted out of the Medicare program, as outlined in 22 M.R.S. § 1771.
• The law does not impose specific limits on membership fees, contract termination notice periods, or the scope of primary care services beyond the core definitional requirements, allowing for flexibility in practice design.

Medication Dispensing

Maine's DPC-specific statutes do not contain explicit rules for in-office medication dispensing. Instead, DPC practices must adhere to the state's general laws governing physician dispensing. Under Maine law (e.g., 32 M.R.S. § 13786), physicians may dispense medications to their own patients, subject to certain limitations and regulations set by the Maine Board of Licensure in Medicine and the Maine Board of Pharmacy. Furthermore, the Health Care Empowerment Act (22 M.R.S. § 1771) supports this practice by stating that providers who have opted out of Medicare may accept direct payment for "medical products," a term that explicitly includes prescription drugs. This provision legally enables DPC physicians to incorporate the dispensing of wholesale medications as a non-insurance-based service for their members.

Medicaid Provisions

Maine law directly addresses the ability of DPC practices to serve Medicaid patients. According to statute 22 M.R.S. § 1771, a physician or other medical professional is not prohibited from accepting direct payment from a Medicaid beneficiary for healthcare services. However, this is only permitted if the provider has officially opted out of the Medicare program. This provision allows DPC practices to contract directly with Medicaid patients outside of the state's fee-for-service insurance system, increasing access to the DPC model for this population. The available research does not indicate the existence of any state-sponsored DPC pilot programs for Medicaid recipients or state employees.