Highlight on Maine: addressing seniors, aliens, diabetes, dental health care

Maine has experienced highs and lows in its delivery of health care in the first half of 2015. It has improved its ranking in the nation in terms of care provided to seniors and on seven measures of a health care index report, but it ranks low in dental health care. To help with those dental statistics, Maine received a grant from HHS targeting children’s dental health. Maine also embarked on a diabetes prevention program. Finally, the Maine Superior Court ruled in favor of the Maine Department of Health and Human Services (DHHS) denying General Assistance welfare reimbursement for claims municipalities paid to nonqualified aliens.

Senior health care ranking

Maine is ranked the 11th healthiest state overall for adults aged 65 and older, up from 14th in 2014. It ranked first in the nation for clinical care, according to the third annual Senior Report released by America’s Health Rankings®. The Senior Report provides a comprehensive analysis of senior population health on a national and state by state basis. According to a news release from MaineHealth, an accountable care organization and integrated not-for-profit health care system of providers and other health care organizations working together in their communities, clinical care includes seniors receiving care for heart attack, heart failure, pneumonia, and surgical procedures.

The Senior Report identified Maine’s strengths as follows: (1) high percentage of quality nursing home beds, (2) low percentage of low-care nursing home residents, and (3) low intensive care unit use. Challenges include: (1) low percentage of dental visit, (2) low prescription drug coverage, and (3) high prevalence of full-mouth tooth extraction. Highlights of senior health care in the past year include that: (1) obesity increased from 25.9 percent to 27.2 percent of adults aged 65 and older; (2) pain management decreased from 50.7 percent to 42.9 percent of adults aged 65 and older with joint pain; (3) community support increased from $525 to $639 per adult aged 65 and older in poverty; (4) home health care increased from 106.3 to 137.4 home health care workers per 1000 adults aged 75 and older; and (5) premature death decreased from 1902 to 1692 deaths per 100,000 adults aged 65 to 74.

Diabetes prevention

The Maine Center for Disease Control (CDC) is targeting diabetes prevention at 16 sites across the state that are delivering the National Diabetes Prevention Program, a year-long lifestyle change program designed to help participants decrease their risk of developing Type 2 diabetes, the Maine DHHS reported on June 11, 2015. The Maine CDC noted that less than 7 percent of Maine adults have ever been told they have pre-diabetes (higher than normal blood sugar) even though the United States Center for Disease Control estimates that one of every three adults has this condition. In 2014, 800 Mainers completed the prevention program in which a lifestyle coach works with small groups of individuals to support life style changes such as changing eating habits, managing stress, staying motivated, and increasing physical activity. Data shows that those who have completed the program reduced the likelihood of developing Type 2 diabetes by 58 percent, and many experienced weight loss and a drop in blood pressure.

Children’s oral health

On July 24, 2015, MaineHealth announced that HHS had awarded the health care organization a grant to improve children’s oral health across the state in the amount of $250,000 per year for a total of $1 million over four years. Maine is one of eight states to receive this funding. The grant expands access to oral health care through the From the First Tooth initiative to include pregnant women and enhance the focus on establishing early dental care for babies. From the First Tooth, which is led and administered by MaineHealth in partnership with MaineGeneral Health and Eastern Maine Healthcare Systems (EMHS), is a statewide effort to integrate oral health into primary care delivery systems through early interventions by pediatricians and family physicians. Kneka Smith, MPH, Director of From the First Tooth at MaineHealth, noted that, “tooth decay is one of the largest health problems impacting Maine children.”

Health Index Report

MaineHealth, released its fifth annual Health Index Report on March 25, 2015. The report, which is released in conjunction with the Robert Wood Johnson Foundation’s County Health Rankings, an annual report that compares the overall health of almost every county in the United States, provides community health data specific to Maine. According to MaineHealth, the rankings compare counties on 30 factors that influence health including education, housing, violent crime, jobs, diet, and exercise. The rankings indicated that Sagadahoc is the healthiest county in Maine and Somerset is the least healthy county. The rankings also showed that Oxford County had the most improved health outcomes in the state. The Health Index Report tracks progress on seven high priority issues that have a major impact on Maine’s overall health status, including: childhood immunizations, tobacco use, obesity, preventable hospitalizations, cardiovascular deaths, cancer deaths, and prescription drug abuse and addiction. Key findings in the 2014 report specific to Maine include:

  • up-to-date immunization rates at MaineHealth practices increased from 77 percent in 2012 to 80 percent in 2014;
  • Maine’s youth smoking rate was 13 percent in 2013 versus the 2011 rate of 15.5 percent;
  • 58 percent of Maine’s adult smokers have made a serious attempt to quit in the past 12 months;
  • 78 percent of Maine fifth graders drank zero sugary beverages per day in 2013–an increase of 9 percent since 2009; and
  • In 2010-2012, Maine’s rates for overall cardiovascular death, as well as rates for heart disease, coronary heart disease and heart attack, were significantly lower than the U.S. rates.

The report identifies opportunities for community health improvement and describes how the MaineHealth system and its partners are addressing the high priority issues through clinical, community, and policy strategies.

Welfare to illegal aliens

On June 9, 2015, the Maine Superior Court, issued a ruling that the Maine DHHS cannot withhold all General Assistance funds from municipalities that give the funds to immigrants seeking asylum until the agency follows state law that outlines how rules may be changed; however, the state does not have to reimburse cities and towns for the aid that they give to asylum seekers, Judy Harris reported in the Bangor Daily News. “DHHS has no statutory or regulatory authority to penalize municipalities for noncompliance with DHHS instruction or directive relating to persons who DHHS deems ineligible for general assistance,” according to the opinion. Finally, the court concluded that until the state legislature enacts laws that allow asylum seekers to receive General Assistance funds, they are ineligible under federal law.

The Portland Press Herald reported on July 13, 2015, that a preliminary analysis by city staff found that “as many as one-third of the 900 or so immigrants who live in Portland and have been at the center of a debate about public assistance may be ineligible for city aid because they have expired visas and have not applied for asylum.” An immigration attorney quoted in the article explained that under federal law, only immigrants who have formally applied for asylum are protected from deportation until their final legal status is determined; asylum applicants are considered to be lawfully present while they wait for a decision. The question is whether someone can be described as an asylum seeker without having formally applied, according to the article.