Challenges to Health Care Access
Access to health care can be complex and becomes more of a challenge in rural and underserved areas of Maine. Challenges include:
- People who have low-income and are uninsured have more trouble finding a health care provider to see them, are less likely to seek medical services, and have greater difficulty paying their medical bills.
- Lack of transportation is the top, non-cost, reason people with low-income delay medical care.
- Almost 20% of adults without a high school diploma do not have a regular health care provider, compared with 14% of high school graduates, 11% of those with some college, and 8% with a bachelor's degree or higher.
- Compared to white adults, members of racial or ethnic minority groups are more likely not to have a regular health care provider (21% vs. 12%) and more likely to have gone without care in the prior year because of cost (17% vs. 10%).
Successes
There are areas Maine is doing well, including:
- The percentage of Mainers reporting poor general health is among the lowest in the nation.
- Maine ranks 2nd in the U.S. for the number of primary care physicians practicing in rural counties (99.5 per 100,000). The national average for rural counties is 54.5 per 100,000.
- Maine ranks 8th in the U.S. for the number of psychiatrists practicing in rural counties. Maine has 6.2 per 100,000 residents. The U.S. rural average is 3.4.
The Health Care Safety Net
Critical Access Hospitals (CAHs)
The Medicare Rural Hospital Flex Program enables certain rural hospitals to be classified as CAH. A CAH is able to improve its financial stability through enhanced Medicare reimbursement and reduced operating costs.
The Rural Health Clinic Services Act was enacted to address an inadequate supply of physicians serving Medicare patients in rural areas and to increase the use of non-physician practitioners, such as nurse practitioners and physician assistants in rural areas. RHCs receive special Medicare and Medicaid rates, depending on the services the clinic provides and the payer mix of the patient population. RHCs may operate as public, private, or non-profit entities.
Federally Qualified Health Centers (FQHCs) and Look-Alikes
FQHCs are safety net providers that provide services typically furnished in an outpatient clinic. FQHCs include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program "lookalikes." They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization.
Our Partners
Collaboration is essential to address rural health in Maine. We work with our colleagues in state government and with stakeholders across Maine
Maine Bureau of Insurance: We collaborate to administer the Rural Medical Access Program. This program provides reimbursement of insurance premiums, to ensure the availability of doctors who provide prenatal care and deliver babies in rural and underserved communities.
Maine Revenue Services: We collaborate to administer the Primary Care Tax Credit Certification Program. An incentive to recruit and retain primary care professionals in areas of Maine with a shortage of primary health care professionals. Eligible primary care professionals must have outstanding student loans and make a commitment to practice full time for five years in an underserved area.
Maine Office of Substance Abuse and Mental Health Services: We collaborate to remove barriers to accessing opioid treatment in rural or underserved areas, including: a lack of clinics, a shortage of providers, lack of transportation, and stigmatization.
Maine DHHS, Division of Licensing and Certification: The Rural Health Clinic program presents an opportunity for enhancing access to health care in underserved areas. Our partners in Licensing and Certification support by performing financial analysis, review and inspection of the clinics.
Maine DHHS, Sentinel Events: Sentinel events are unexpected events that result in death or serious harm to a patient while in the care of a medical facility. The Sentinel Events team works with our Critical Access Hospitals and licensed personnel in rural facilities to educate and provide feedback to improve processes. They also partner with us to conduct no and low-cost training to medical personnel.
Maine Primary Care Association (MPCA) and Maine Hospital Association (MHA): MPCA strengthens and supports Community Health Centers through education and training in health care policy, quality, and innovation. MHA supports its member hospitals by providing education services, resources, and advocacy. We coordinate activities, share data and expertise to maximize the impact of our organizations for the benefit of all Mainers, especially those residing in rural and underserved areas.
Maine Area Health Education Centers: Our staff participate on the Area Health Education Center Committee. The Committee provides guidance and support for the network to abate health workforce shortages in rural and underserved areas by providing pipeline programs to: engage students in health career exploration, clinical training programs in rural and underserved areas and continuing education programs to support practice, reduce professional isolation, disseminate best practices, improve quality of health care and reduce health disparities.
Maine Health Workforce Forum: The Forum is convened by the Program and seeks to ensure a sufficient supply of qualified health care providers in Maine by establishing plans, holding meetings, publishing reports, sharing information, coordinating resources, collecting and analyzing data, and providing guidance to policy makers. Forum membership includes Program staff, employers, medical professionals, associations, licensing boards, and educational institutions.
Northeast Telehealth Resource Center: Telehealth can be one solution to increase access, integration of care, and learning opportunities for providers in rural areas. Program staff attends meetings and provides support to promote the use of telemedicine and to provide education, to include a webinar series, telehealth summit, and case-based Project Echo sessions.