Mental Health Status and Access to Health Care Services for Adults in Maine

Maine people with poor mental health describe significant challenges with affordability and access to health care. A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected. Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk Factor Surveillance System (BRFSS), Dr. Ziller found that adults in Maine experiencing 14 or more mental health bad days are less likely to have a regular health care provider and more likely to report delays in getting needed health care services (for reasons other than cost). Poorer mental health status was associated with higher rates of foregoing needed medical care because of costs; 25 percent those adults experiencing 14 or more mental health bad days reported they were unable to access needed care from a doctor due to cost compared to 7 percent of adults with no mental health bad days. MeHAF support allows inclusion of additional questions about access to insurance and health care services in the state’s BRFSS, which surveys a random sample of Maine people throughout the year. Results from the compiled 2012, 2013 and 2014 surveys are included in the report

Sociodemographic and Health Status Characteristics of Maine\u27s Newly Eligible Medicaid Beneficiaries [Data Brief]

This data brief identifies key characteristics of groups who will gain access through MaineCare expansion. Researchers Croll and Ziller at the University of Southern Maine, along with Leonardson of the Maine Health Access Foundation present a statistical analysis of uninsured non-elderly adults age 18 – 64 with no children and lower incomes, the population newly eligible for MaineCare through expansion. Drawing from five years of data from Maine’s Behavioral Risk Factor Surveillance System, the report addresses sociodemographic characteristics, health status, and access to care. The survey indicates that those who are likely eligible for expanded MaineCare coverage are twice as likely as other nonelderly adults to be aged 55-64, and are more likely to be unmarried and live in small or isolated regions of North and Downeast Maine. Only 11% of these individuals have a bachelor’s degree or higher. Thirty-three percent of these adults have not seen a doctor in the last year due to cost, and 20% have not received a routine checkup in five or more years. Overall, the newly eligible adults are more than three times as likely to self-report their health as fair or poor. The report also notes that this group is more likely than others to face issues with depression, obesity, smoking, and other chronic diseases. However, they are no more or less likely than other nonelderly adults to struggle with substance use disorders

Access to Health Care Services for Adults in Maine [Policy Brief]

This data brief by researchers at the Maine Health Access Foundation and the University of Southern Maine\u27s Maine Rural Health Research Center found ongoing inequality in the ability of people in Maine to get quality health care. The report examines data from 2014-2016 and shows that Maine people, of all income groups, report difficulties in paying medical costs. Research has also found the ability to seek timely and appropriate health care is impacted by income levels, educational background, race and ethnicity. This brief provides an update to the 2016 study (available in Digital Commons: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1038&context=insurance) For more information, please contact Dr. Erika Ziller ([email protected]

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Low-Income, Uninsured Mainers Face Substantial Challenges Getting Health Care

Focusing on adults age 18 – 64 with incomes below 138% of the Federal Poverty Level (in 2018, about $22,715 per year for a family of two), findings from the study by researchers at the University of Southern Maine’s Muskie School of Public Service and the Maine Health Access Foundation show that uninsured, low-income Mainers have trouble finding doctors, getting health care appointments, and paying for care. Compared with their insured counterparts, a higher percentage of uninsured, low-income Mainers went without or delayed care, or were unable to purchase needed prescriptions. Over half of uninsured, low-income adults in the study sample reported that they did not have a usual source of care. With no usual source of care, people are less likely to receive preventive care, quickly address new health issues, and get support for chronic conditions like diabetes and heart disease. Over half of low-income, uninsured survey participants also reported they had problems paying medical bills. Even one third of low-income individuals with coverage reported such problems. Data notes: The findings in this data brief are based on data from Maine’s oversample of the Health Reform Monitoring Survey (HRMS), a national survey of the nonelderly population designed to monitor the Affordable Care Act. The core HRMS is funded by the Robert Wood Johnson Foundation and the Urban Institute, and the Maine Health Access Foundation has supported an oversample for Maine during Quarter 4 2013, Quarter 4 2014, Quarter 1 2016, and, Quarter 1 2017. For more information on this study and its methods, please contact Dr. Ziller at [email protected] Media contact: Barbara Leonard, President & CEO, Maine Health Access Foundation, 207.620.8266 x102, [email protected]

Harnessing the Combined Strengths of a National and a Local Funder to Bolster Maine Medicaid Expansion

Researchers at the University of Southern Maine\u27s Muskie School of Public Service conducted an evaluation of a partnership between the Robert Wood Johnson Foundation (RWJF), the Maine Health Access Foundation, and Maine’s Department of Health and Human Services to support Medicaid expansion through outreach to under-represented communities and data analysis of health system capacity. The evaluation sought to provide RWJF with lessons learned for potential replication in other states. The blog post describes some of the findings from the evaluation, including the important role of the local funder in facilitating the work, the valuable opportunity for key stakeholders in Maine to develop new relationships and strengthen existing ones, and insights around equity in MaineCare (Medicaid) outreach and enrollment