Fund for a Healthy Maine:Creating Opportunity for Greater Health and Lowering Costs for Everyone
The Challenge 75% of health care costs are the result of chronic disease. (CDC)
The Challenge Maine spends approximately $8 billion on health care costs each year. The Fund for a Healthy Maine, Maine’s only source of State funds for prevention, accounts for only .7% of Maine’s total health care expenditure.
The Challenge Maine’s Current Health Cost Investment Structure* Investing in Prevention Reduces Overall Health Costs Prevention Prevention Pre-Disease Treatment Pre- Disease Treatment Care for Disease Care for Disease PreventionGreater investment in preventive medicine and education helps to dramatically reduce chronic disease, thus decreasing long-term treatment costs to Maine and its residents. *Charts represent the total funding to each health-related function.
Overview of the FHM• The Fund for a Healthy Maine (FHM) was created by the Maine Legislature in 1999 to receive and disburse Maine’s annual tobacco settlement payments. Maine participated in the national tobacco settlement because many Maine people have suffered disease and death as a result of tobacco use encouraged by the deceptive practices of the tobacco industry.• The Fund for a Healthy Maine is not taxpayer dollars. Because of its special source, the FHM has a special purpose – to prevent disease and promote good health among Maine children and adults. The FHM is meant to ―supplement, not supplant‖ existing dollars!
Overview of FHM (cont.)• FHM revenue is not part of Maine’s General Fund account. It originates in the FHM account and only ends up in the General Fund if lawmakers divert it there. FHM program allocations are made directly from the FHM account and do not pass through the General Fund.• By statute, allocations from the FHM must be used to supplement, not supplant, appropriations from the General Fund. It was intended that the FHM be used for new and expanded programs. The FHM was not intended to be used to balance the state budget or spent on non-health- related programs.
Allocation Since Inception: The Vision 90% Program 10% FHM -Substance Abuse Spending Trust Fund Prevention & Treatment -Prescription Drugs for the Elderly -Child Care -Oral Health - School Health Program -Tobacco Prevention, Treatment & Control The Vision: -Home Visitation New and -MaineCare Expanded Health Programs
Overview of FHM (cont.)• Unfortunately, these provisions have been ignored in the past and the FHM has lost 17.1% of its resources ($126.8 million) to the General Fund – a significant missed investment in getting and keeping Maine people healthy.
Allocation Since Inception: The Reality17.1% Diverted 82.9% Programto General Fund -Child Care Spending(trust fund abolished) (allocated or reserved) -Oral Health -Home Visitation -Prescription Drugs -Tobacco Prevention and Treatment -Substance Abuse Prevention & Treatment -School Health Program -MaineCare The Reality: $126.8 million diverted or approved for diversion through FY 13
Overview of FHM (cont.)• The Maine Legislature decides how FHM dollars are allocated within the eight FHM categories. FHM allocations and diversions are currently decided as part of the state’s overall budget process.
FHM Financial Present and Future MSA payments continue in perpetuity
Purpose of the FHM FHM funds should not replace General Fund allocations to MaineCare. WHY?BY LAW: FHM funds must be used to ―supplement, not supplant‖ General Fund spending.FUNDING PROVIDED: FHM monies already go to fund health care initiatives for children and parents.ORIGINAL INTENT: Founders believed the FHM should be used primarily to prevent disease, improve health status, and reduce future health costs.FISCAL RESPONSIBILITY: 75% of health care costs are the result of chronic disease, and most chronic disease is preventable. The best way to get health care costs under control is to PREVENT chronic disease, not pay for it after the fact.
FHM Impact-Once in a Lifetime Opportunity The success of FHM programs will directly affect Maine’s ability to stabilize health costs and their impact on Maine businesses, individuals, and the state budget.
Purpose of the FHM • Preventing chronic disease • Improving health status • Reducing future health costs
FHM Programs: Budget Allocations by Program in FY 2012 Family Planning Home Visitation School Breakfast Program Transfer to $401,430 $2,653,383 $213,720 the 0.8% 5.1% 0.4% General Substance Abuse Fund $3,105,972 $1,375,000 6.0% 2.7% Dirigo Health Program $1,161,647 2.2% Oral and Dental Health $874,203 1.7% Tobacco Prevention and Control* $14,180,059 Medicaid Initiatives 27.4% $7,876,677 15.2% Attorney General Health Education Centers Child Care $111,840 $100,353 $5,296,816 0.2% 0.2% 10.2% Immunizations Prescription Drugs for the $1,078,884 Elderly and Disabled ** 2.1% $11,934,230 23.1% Public Health Infrastructure $1,366,802*A total of $9,358,839 (66%) spent directly on tobacco prevention, treatment, and control. 2.6%**Includes $4,500,000 in Racino funds.***Does not include $1,891,952 used to pay back FY 11 cash advance. Total Allocations: $51,731,016***
Racino Funds: Drugs for the Elderly and Disabled10% of net slot machine income must be credited to the FHM each year to be used only for prescription drugs for the elderly(see 8 MSRA Sec. 1036, 22 MSRA Sec. 1511, 6 (E))
FHM Programs: Overview The Legislature established eight categories of allowable health program spending:o Smoking prevention, cessation and control activities, including, but not limited to, reducing smoking among the children of the State;o Prenatal and young childrens care, including home visits and support for parents of children from birth to 6 years of age;o Child care for children up to 15 years of age, including after-school care;o Health care for children and adults, maximizing to the extent possible federal matching funds;o Prescription drugs for adults who are elderly or disabled, maximizing to the extent possible federal matching funds;o Dental and oral health care to low-income persons who lack adequate dental coverage;o Substance abuse prevention and treatment; ando Comprehensive school health programs, including school-based health centers.
FHM Programs: Tobacco• High school smoking declined by 64% between 1997 and 2007. In that same period, middle school smoking has declined by 73%.• Maine’s Tobacco HelpLine has served over 75,000 Maine residents since its inception in 2001.• The Healthy Maine Partnerships (HMPs) are engaged in over 800 health initiatives across the state to change local attitudes about tobacco use, and increase physical activity and healthy eating. The HMPs have enlisted 2,300 volunteer coalition members throughout Maine.
FHM Programs: Tobacco andHealthy Maine Partnerships―Im known as Vegas girl. I quit smokingin January, the day before I flew to Vegas.I smoked for approximately 32 years. I,for the first time in years, had a veryhealthy winter with no bronchitis orsinus infections and (saved tons ofmoney)! If it wasnt for all thephenomenal support and weekly lettersfrom Healthy Androscoggin I feel I wouldnever have been so successful. Thesupport was amazing and I am so proudof me and Healthy Androscoggin.― —Michele Wagner, 48 of Lewiston, was a participant of Healthy Androscoggin’s (a Healthy Maine Partnership) Quit & Win Program. Michelle quit smoking to regain her singing voice, which she was able to do last year, literally singing her song of praise to the staff.
FHM Programs: Child Care• About 3,000 children, ages birth – 12, currently receive child care, Head Start, or after-school programs each year.• Nearly 2,500 children, ages 12 - 15, participate in a range of recreational, cultural, academic, and arts programs after school and in the summer.• Child care programs promote preventative health care that provides families with the opportunity to identify and treat health problems before complication occur. Programs, like Head Start, collaborate with families, staff and health professionals to identify child health and development concerns and link children and families to an ongoing source of continuous, accessible health care.
FHM Programs: Child Care Head Start• 100% of enrolled pregnant women received prenatal and postpartum health care, education on fetal development and benefits of breastfeeding. Over 63% of pregnant women received mental health interventions. The majority of pregnant women were enrolled in program during their 1st trimester.• Over 98% of children had a medical home by the end of the enrollment year.• Over 77% of children received all medical screenings. Of those who were identified as needing medical treatment almost 98% received treatment.• Almost 79% of children had a dental home at the end of the program year; 76% completed dental exams. Of those needing dental treatment 71% received treatment.• Almost 97% of children were up-to-date on all immunizations or had received all immunizations possible by the end of the enrollment year.
FHM Programs: Child Care ―I was homeless and needed care for my 4 year old son. Through assistance from the Fund for a Healthy Maine, my son received full-day Head Start service, including nutritious meals. Staff also helped me get the dental and health care he needed. The supports gave me the opportunity to look for a job. I found employment and got an apartment. We are happy and excited to be together in our own home.‖ -Roxanne, Head Start parent
FHM Programs: Substance Abuse• The overall lifetime alcohol use rate among Maine’s 6th to 12th grade students had dropped consistently over the past decade-from 70.7% in 1995 to 44.3% in 2008.• Maine’s Higher Education Alcohol Prevention Partnership (HEAPP) is a partnership between Maine’s colleges and universities and the Maine Office of Substance Abuse to bring about long-term, systemic change in how high risk drinking and other substance abuse issues are addressed at the state and local levels. From 2000 to 2010 the number of colleges and universities participating has increased from 4 to 18.
FHM Programs: Substance Abuse ―The Sebasticook Valley Healthy Communities Coalition has developed Youth Advocacy Programs in Pittsfield and Newport (a total of 4 groups). These middle school and high school programs work together to promote physical activity and nutrition; and prevent substance abuse and tobacco use. A couple of examples: we held a sledding event this past winter and we also held healthy youth activities this summer at the fair in Pittsfield. Both had great turnouts.‖ -Kristen Webster Substance Abuse Coordinator, Pittsfield
FHM Programs: Substance Abuse―One of its current residents, an 18 year-oldyoung man, grew up in an alcoholic anddrug abusing family. He began to use drugsat age 9. By 16 he had moved out of hishome, dropped out of school and was introuble with the law. Day One gave him achance to become the kind of person hewanted to be. He is now sober and healthy,has forged caring relationships and isworking toward his GED. He will graduatefrom the program in one month.‖ -Rebecca Howe, Day One
FHM Programs: School Based Health Centers• Maine has 25 School-Based Health Centers (SBHC) in 16 communities. SBHCs deliver primary care medical services and preventive health services to students whose parents have enrolled them in a SBHC. Some SBHCs also provide behavioral health and/or oral health services.• In the 2009/2010 school year 7,121 students were enrolled in SBHCs. There were 13,108 encounters including acute care, behavioral health, oral health and preventive health visits. More than one third (35%) of students who smoke and were seen at a SBHC reported that they reduced their smoking or quit smoking as a result of their visit.• More than half (56%) the SBHC users who have asthma have an up-to-date asthma plan on file, up from 31% the previous school year.• More than three-quarters (76%) of SBHC users who were identified as being depressed were done so using an evidence-based screening tool.• Close to half (42%) of medical encounters were for a preventive health purpose (e.g., immunization, health counseling, physical exam).
FHM Program: School Based Health Centers ―The Mission of the Maine Assembly on School- Based Health Care (MeASBHC) is to ensure that all Maine Students have access to healthcare through advocacy, promotion, support and sustainability of school-based health centers at the local, state and national levels. School-Based Health Centers help keep children in school, increasing their chances of success as students and as citizens. The MeASBHC advocates that the health needs of students be addressed in the place they spend the most time, at school. Student-centered care creates a safe, comfortable and confidential environment where adolescents receive the health care they need. The FHM helps support some of Maine’s SBHCs as well as other health programs across the state.‖ --Cindy Flye, President, Maine Assembly on School-Based Health Care
FHM Programs: Oral Health• The Dental Subsidy Program supported 11 community based agencies in providing over 33,700 dental services to nearly 18,400 patients in 15 locations during the 2010 fiscal year.• 25% of Maine dentists participate in the Donated Dental Services Program providing free services to qualified disabled and elderly individuals through a FHM paid coordinator• The Dental Education Loan & Repayment Program has awarded 25 loans to dental students who have or will return to Maine and 15 loan repayment awards to dentists practicing in underserved areas and who see all patients.
FHM Programs: Oral Health ―The case management services made possible through these funds continues to be a vital part of the Children’s Oral―The Washington County Health Program. . . We areOral Health Task Force able to have children whowouldn’t have happened receive urgent referrals,without these funds.‖ indicating pain and/or -Sherri Camick, RDH abscess, seen almost Dental hygienist, Eastport immediately.‖ -Kathy Martin, RHD, MS Director, City of Portland Children’s Oral Health Program
FHM Programs: Teen Pregnancy Prevention• Maines teen pregnancy rate decreased by 48% between 1988 and 2005, one of the most dramatic decreases in the nation. Maines rates of teen pregnancy and teen birth are among the lowest in the nation.• The percentage of high school students who have ever had sexual intercourse has declined from 52% in 1997 to 45% in 2007.• Among high school students who are sexually active, the percentage who used a condom during their last sexual intercourse has increased significantly from 51% in 1997 to 59% in 2007. The percentage who used birth control pills has increased from 30% in 1997 to 41% in 2007.
FHM Programs: Teen Pregnancy Prevention―I am grateful that Glenn(PPNNE Educator) could lead ―You really opened my eyesus to have such a positive about relationships andoutlook especially with my what I want. I hope youfoster kids’ background and continue to help usexperiences, and that they students."came away feeling betterabout themselves and - 8th Grade student, Memorial Middle School, So. Portlandoptimistic about theirfuture. Thank you.‖ - Parent of youth participant
FHM Programs: Home Visitation• 72% of participants whose children were exposed to secondhand smoke reduced or eliminated their childs exposure.• Children in the program are routinely screened for developmental delays. Seven percent of those screened were referred for further evaluation, and as a result 72 percent of those children referred through home visiting received needed services to address developmental issues.• Due to the focus on improving health outcomes for children, 99.5% of children had a primary care provider, 98% were up-to-date on well-child exams, 95% had health insurance and 93% were up-to-date on childhood immunizations.• To help families increase self-sufficiency and access needed resources, program staff partner with and make a significant number of referrals to community resources. Maine Families staff made more than 23,000 referrals on behalf of families this past year.
FHM Programs: Home Visitation"As a new parent, the deluge of informationyou are left to sort through in the first days,weeks, and months of your childs life isoverwhelming at best. The KVCAP HealthyFamilies program is a valuable resource for anyfamily facing this challenge for the firsttime. From day one my son, Logan, was notso easy to console. He was very colicky and Ioften felt helpless as to how to comfort myson. In addition to providing the most up todate and credible information on health,safety, and development, my representativeshowed me educational activities to enrich andencourage the mental and physical growth ofmy son. By keeping me informed and providingsupport, KVCAP Healthy Families helped mebecome the best parent I could be.‖ -Misty Dostie Parent, Augusta
FHM Programs: MaineCare• The Fund for Healthy Maine provides critical health care coverage through the MaineCare program for thousands of low-income Maine families who would otherwise be unable to afford health insurance for themselves and their children.• Coverage for children is a wise investment. Children without coverage are more likely to go without immunizations, end up in emergency rooms when simple conditions turn complicated due to a lack of primary care, and miss school because of untreated illnesses.• The first-ever state-by-state health system "scorecard" on childrens health care released by the Commonwealth Fund in May, 2008 ranked Maine third in the nation in overall performance. The Fund for a Healthy Maine’s investment in children’s health care has helped Maine to be a leader in this area.
FHM Programs: MaineCare ―The MaineCare program allows families like mine to meet the health care needs of our children, thereby assuring not only healthier children, but a better quality of life for all of us. Just the cost of my two children’s annual well child visits and their biannual visits to the dentist would be unaffordable on my salary. Taking care of illnesses before they become so serious as to need hospitalization or a trip to the Emergency Room benefits my children, myself, my employer and the whole health care system. Because of the MaineCare program, families like mine do not need to suffer the fear and anxiety caused from living without health care coverage for our children.‖ -Jami Collins MaineCare recipient, Steep Falls
FHM Programs: Drugs for the Elderly• The Drugs for the Elderly and Disabled (DEL) program helps low- income elderly and people with disabilities to access the prescription drugs that they need.• Many elderly and people with disabilities in Maine struggle on fixed incomes to make ends meet and would be unable to pay for their prescription drugs without the help of the DEL program.• As of January 2011, the DEL program is: • Assisting 41,076 low-income elderly and people with disabilities with their Medicare Part D expenses to ensure that they are able to access needed prescription drugs. • Helping more than 4,000 low-income elderly and people with disabilities who are not receiving coverage through Medicare Part D to purchase needed prescription drugs.
FHM Programs: Drugs for the Elderly ―I worked all my life as a tire salesman until my diabetes forced me to retire. I live on the limited income I receive from my Social Security check. My medical condition is extremely fragile. I have serious problems with my kidneys as well as my right foot and my legs due to bad circulation. When I had to switch over to Medicare Part D program, I was nervous that I would lose access to needed prescription drugs. The Drugs for the Elderly program has guaranteed that I can continue to get the life saving prescriptions that I take for my heart, cholesterol, diabetes and high blood pressure.‖ -Paul Boutin, DEL recipient, Augusta
Protecting the FHM: Today’s Challenges• The FHM saw trouble from day one: • Abolishment of the trust fund • Large chunks of the Fund diverted before receipt • Diversions and program supplantation• Attempts to protect the Fund for a Healthy Maine have met with overall popularity, but ultimately failed: • Constitutional amendment • Cascading funds • Separate votes• With the advent of term limits, there are fewer legislators who were present when the original plan was established. More recently elected officials may not understand that this is special funding and not simply General Fund or another Rainy Day Fund.
Why Protecting the FHM is Important• Every $1 taken from FHM prevention programs will add at least $7.50 to Maine’s future health costs. Savings estimates go higher, but one thing is clear: the FHM is an investment in our future health and financial well-being. Every $1 taken from the FHM today will be $1 that is not available to fund prevention programs for our most at-risk citizens that improve oral health, reduce substance abuse, enhance physical activity opportunities, provide child care and home visits to new parents, support family planning, and prevent tobacco use among Maine children. Every one of these efforts will significantly reduce Maine’s health care costs.• The FHM is a nationally recognized success story. Maine’s use of tobacco settlement dollars and specifically Maine’s tobacco prevention and treatment program continue to draw both national and international recognition for their comprehensive approaches to preventing costly health care.
Why Protecting the FHM is Important (cont.)• Maine has made tremendous progress in reducing tobacco use, but significant challenges remain. 18.1% of Maine youth smoke, health costs from tobacco use still total over $600 million per year, and 2,200 people still die every year from smoking.• Tobacco companies are anxious for Maine to ease up. Despite being a small state, Maine has made life difficult for the tobacco companies and their allies. They want Maine to make the same mistakes as Massachusetts and Florida, where youth smoking rates skyrocketed when tobacco programs were reduced.• Tobacco companies oppose cigarette price increases and want you to believe that “we’re all done” when it comes to keeping kids from smoking. Yet they are far from done in promoting their deadly products - spending $59 million every year in Maine to find the ―replacement smokers‖ their internal documents describe.
Why Protecting the FHM is Important (cont.) Protecting the Fund for a Healthy Maine is Maine’s best hope for getting health care costs under control. Support of the Fund for a Healthy Maine means supporting reduction in health care costs, preventing chronic disease and helping Maine people get healthy!
Friends for the Fund for a Healthy Maine The following organizations strongly endorse efforts that will keep tobacco settlement money used as it was intended and prevent further diversions away from the Fund for a Healthy Maine. ACCESS Health Greater Watervilles Comm. for Children ME/National Assoc. of Social Workers Penobscot Community Health Center Advocates for Children Harrington Family Health Center Maine Child Care Directors Association Penobscot Dental Access CoalitionAlliance for Childrens Care, Education and Regional Medical Center at Lubec Maine Children’s Alliance Penquis Supporting Services Healthy Acadia Maine Children’s Trust Penquis CAP American Cancer Society, NE Division Healthy Androscoggin Maine Co-Occurring Policy Exchange People’s Regional Opportunity Program American Heart Association Healthy Aroostook Maine Council of Senior Citizens Phoenix Academy of Maine American Lung Association in Maine Healthy Casco Bay Maine Dental Access Coalition Piscataquis Public Health Council American Nurses Association of Maine Healthy Communities of the Capital Area Maine Education Association Planned Parenthood of Northern NE Androscoggin Cardiology Associates Healthy Community Coalition Maine Equal Justice Power of Prevention Androscoggin Head Start & Child Care Healthy Lakes Region Maine General Health Project Integrate Anthem Blue Cross Blue Shield Healthy Lincoln County Maine Head Start Director’s Association River Coalition Aroostook Council for Healthy Families Healthy Oxford Hills Maine Hospital Association River Valley Healthy Communities Coalition Aroostook County Action Program Healthy Peninsula Maine Medical Association Roman Catholic Diocese of Maine Aroostook Mental Health Services Healthy Portland Maine Nurse Practitioners Association Sebasticook Valley Healthy CommunitiesBangor Region Public Health and Wellness Healthy Rivers Region Maine Osteopathic Association Serenity House Breathe Easy Coalition of Maine Healthy Waldo County Maine Peoples’ Alliance Southern Kennebec Healthy Communities Bridgton Community Center Horace Mitchell Primary School Maine Primary Care Association Southern Kennebec Child Development Bucksport Bay Healthy Communities Islands Community Medical Services, Inc. Maine Public Health Association Corp. Coalition Katahdin Area Partnership Maine School Health Education Coalition St. Croix Valley Healthy Communities Care Link/MRDC, Inc. Katahdin Valley Health Center Maine Society for Respiratory Care Start ME Right Caribou City Council Kennebec Behavioral Health Maine State Chamber of Commerce Teen and Young Parent Program of Knox Child & Family Opportunities, Inc. Kennebec Valley Community Action Maine State Nurses Association Co. Child Care Services of York County Program Maine Substance Abuse Foundation The Community School Children’s Dental Clinic Kennebunkport Public Health Department Maine Winter Sports Center Town of Lincolnville Choose To Be Healthy Kittery Children’s Leadership Council Maine Women’s Lobby Town of Van Buren Recreation Department City of Portland Kittery School Department MaineHealth Tri-County Mental Health Services Coastal Enterprises, Inc. Kno-Wal-Lin Homecare and Hospice ME Assoc. of Child Abuse and Neglect Union River Healthy Communities Coastal Healthy Communities Coalition Knox County Community Health Coalition Council United Way of Mid-Maine Common Cause Maine Legal Services for the Elderly ME Assoc. of Health, Phys.Ed., Rec. & University of Maine Community Concepts, Inc. Lewiston Public Schools Dance Vital Pathways Consumers for Affordable Health Care Maine AFL-CIO Medical Care Development Waldo County Dental Task Force Day One Maine Alliance for Addiction Recovery Midcoast Maine Community Action Waldo County Head Start Downeast Health Services, Inc. Maine Alliance to Prevent Substance Abuse Mid-Maine Chamber of Commerce Wellspring, Inc. Downeast Healthy Tomorrows ME Assoc. of Interdependent Milestone Foundation Winter Kids Family Planning Association of Maine Neighborhoods MDI’s Behavioral Health Center York County Community Action Corp. First Congregational Church Maine Association of School Nurses My Attitude Saves Kids York HospitalGreater Portland Chambers of Commerce Maine Association of Substance Abuse Northern Maine Medical Center Youth Promise