Geography and Demographics

  • Maine is considered the most rural state in the nation;
  • 50% of Maine's Land area is almost completely uninhabited;
  • Not only is Maine the most rural, but it is also the oldest state by median age; and
  • 40% of the population lives in one of Maine's 11 rural counties.
  • Am I rural?

Challenges to Health Care Access

  • Using data from the 2013-2017 Health Reform Monitoring Survey, it was determined that low-income uninsured Mainers, when compared with those insured, have more trouble finding a health care provider to see them, are less likely to seek needed medical services, and have greater difficulty paying their medical bills when they do obtain health care;
  • According to data from the Maine Behavioral Risk Factor Surveillance Survey, groups of Medicaid enrollees, low-income adults and low-income adults 65 and over cited lack of transportation as the number one non-cost reason for delaying medical care therefore confirming transportation as a factor in access to health care;
  • A review of the data from Maine’s Behavioral Risk Factor Surveillance System found 19% 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; and
  • Maine's Behavioral Risk Factor Surveillance System Survey also showed that compared to white adults, members of racial or ethnic minority groups are: twice as likely to lack a regular health care provider (21% vs. 12%), less likely to have had a check-up in the prior year (66% vs. 72%), and more likely to have gone without care in the prior year because of cost (17% vs. 10%).

The Successes

  • The percentage of Mainers reporting poor general health is among the lowest in the nation. The state ranked 14th for rural counties (13.9 percent);
  • 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; and
  • 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 Flexibility (Flex) Program, established by the Balanced Budget Act of 1997 (Public Law 105-33) enables certain rural hospitals to be classified as Critical Access Hospitals (CAH). A CAH is able to improve its financial stability through enhanced Medicare reimbursement and reduced operating costs.

Rural Health Clinics (RHCs)

The Rural Health Clinic Services Act of 1977 (Public Law 95-210) 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 (NPs) and physician assistants (PAs) in rural areas. RHCs receive special Medicare and Medicaid rates, depending on the type of services that 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

The FQHC benefit under Medicare was added effective October 1, 1991, whenSection 1861(aa) of the Social Security Act (the Act) was amended by Section 4161 of the Omnibus Budget Reconciliation Act of 1990. FQHCs are safety net providers that primarily 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.