Maine\u27s Rural Health Challenges

This brief describes the issues affecting access to health care in rural Maine. These issues include Maine’s use of enhanced Medicare and Medicaid payments to support the rural health infrastructure, the adequacy of the provider workforce and the presence of training programs, the contribution of health care to the rural economy, and the high prevalence and unmet need for care for persons with substance use and mental health issues

Distribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum [Working Paper]

Released in June 2008, this study examines the distribution of substance abuse treatment services across the continuum of rural and urban counties, identifying the type and intensity of services provided. Using the 2004 National Survey of Substance Abuse Treatment Services linked to the 2003 Rural-Urban Continuum Codes, we found few substance abuse treatment facilities operating outside of urban and rural adjacent areas and limited availability of intensive services across rural areas. This situation is particularly striking for opioid treatment programs, which are nearly absent in rural areas. The narrow range of services available in rural areas may preclude an individualized treatment approach and long-term follow-up recommended by professional organizations and other experts. The greater proportion of rural-based facilities accepting public payers and providing discounted care may reflect higher rates of uninsurance and underinsurance

Distribution of Substance Abuse Treatment Facilities Across the Rural-Urban Continuum [Policy Brief]

Key Findings: Access to substance abuse treatment is limited in rural areas by fewer treatment beds. Less populated rural areas contain a small proportion of facilities offering a range of core services and varying levels of outpatient and intensive services. Opiod treatment programs are nearly absent in rural areas

Policy Issues Affecting Maine’s Hospitals

Legislators and other policymakers will be continually challenged to balance the needs of hospitals for appropriate reimbursement and oversight with supporting their provision of important services to local communities

Rural-urban differences in health care access vary across measures

Rural uninsured rates are higher than urban,1 and the uninsured often have difficulty obtaining needed care.2 Difficulties recruiting and retaining health care providers have resulted in longstanding disparities in rural and urban physician supply.3 This combination of factors suggests that rural residents may face greater barriers to accessing health care than their urban counterparts. Analyses of data from the 2006 Medical Expenditure Panel Survey (MEPS) for non-elderly rural and urban residents partly supports this premise, yet rural residents fare better on some measures of access

Medicaid Income Eligibility Transitions Among Rural Adults

The Affordable Care Act (ACA) Medicaid Expansion allows coverage for all adults aged 18 to 64 with income below 138 percent of the federal poverty level (FPL), and as of 2018, 32 states had implemented expansion. Research prior to the ACA suggests people may transition in and out of Medicaid income eligibility, but little is known about how this may affect rural adults. Movement in and out of Medicaid may increase administrative costs, create benefit and provider discontinuity, or lead to patient difficulties in paying medical bills and accessing care. This brief uses data from the national Survey of Income and Program Participation to examine the extent to which rural and urban residents’ incomes shift above or below the Medicaid expansion eligibility threshold of 138 percent of FPL during a calendar year (2010). We find that in 2010, rural adults were more likely than those in urban areas to begin the year with incomes below 138 percent of the federal poverty level, particularly in states that did not expand Medicaid. Compared with their urban counterparts, rural adults were also more likely to experience an income shift during the year that would have changed their eligibility for expanded Medicaid. This somewhat higher rate of income eligibility transition among rural versus urban adults appears to be driven by the generally lower incomes of those in rural areas and could have implications for rural individuals, communities and states

A Review of the Literature on End-of-life Care: Setting a Research Agenda for Maine

In 2002, Last Acts, a national campaign of the Robert Wood Johnson Foundation, issued a report assessing the states on access to end-of-life care and policies supporting its provision. Quite striking for the hospice providers and other stakeholders of Maine, the state ranked second to last in hospice use among persons over age 65 in their last year of life. Although anecdotal and unpublished data suggest that hospice use is on the rise in Maine, concerns about the low use rate remains a concern to those interested in end-of-life care in the State. In order to better understand the factors influencing the use of hospice in Maine, the Maine Hospice Council asked the Muskie School of Public Service to conduct a literature review synthesizing current knowledge on outcomes, use, cost, and barriers to end-of-life care. This review provides a foundation for setting an overall research agenda for the Council. At the end of the report, we have outlined a set of questions for further research regarding end-of-life care in Maine

The Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children

Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study examined rural-urban differences in children’s access to care, and their families’ perceived affordability of that care among those enrolled in Medicaid or CHIP and those covered by private insurance. Findings indicate that public coverage supported access to care for low-income rural children and low-income rural families reported fewer problems paying medical bills for their child’s care. CHIP is up for reauthorization in 2017 and decisions about the program’s future should consider the potential implications for affordability of healthcare services among rural children