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State News

Maine

For years, Maine has been a health policy innovator, most recently focused on closing the coverage gap and transparency initiatives. In 2019, Maine became the 33rd state to expand Medicaid after being approved by state voters in 2017. The Maine Health Data Organization and the Maine Quality Forum developed CompareMaine, a consumer-focused website that provides average costs for specific procedures, patient experience ratings and patient safety scores. In addition, Maine has focused on rural health issues. In 2019, Maine passed a bill that required all private payers to cover telehealth services in an effort to increase accessibility for individuals in rural areas. Additionally, the Maine Health Access Foundation has worked to provide Rural Health Transformation Grants to low-income counties in Maine. 

Maine created of one of the first all-payer claims databases, a key tool in addressing high healthcare costs but the state has yet to enact strong measures to combat excess prices or reduce the provision of unnecessary services.  A major study comparing hospital pricing found that private payers in Maine paid 283% of what Medicare paid for hospital services.

Maine ranked 8 out of 47 states plus DC, with a score of 53.7 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.


Maine | Jan 5, 2024 | Report | Consolidation

Hospital Consolidation Drives High Health Care Costs in Maine

A case study by Third Way finds that hospital consolidation has driven up the cost of care in
Maine, reports Bangor Daily News. Costs in Maine are the highest in New England and exceed
the national average by 25 percent. The study recommends that state and federal lawmakers
strengthen hospital price transparency, limit facility fees and restrict tactics that reduce
competition when negotiating insurance contracts.


Maine | Mar 13, 2023 | News Story | Health Costs

Poll: Most Mainers Think Access to Affordable Health Care for Everyone Should be a Priority

A new survey found that 83 percent of voters in Maine believe that all residents, regardless of immigration status, should have access to low-cost health care, reports the Beacon. The survey aims to measure the impacts the cost of health care and insurance have on residents’ ability to access needed care. Maine’s Medicaid program is available to people who are pregnant and those under age 21, regardless of immigration status, but does not provide coverage for other adults.


Maine | Feb 27, 2023 | Report | Drug Costs

International Referenced Rate Pricing for Prescription Drugs

A new report provides information on potential savings for prescription drugs by using international reference pricing with costs from several Canadian provinces, from the Maine Health Data Organization. The report focused on the most expensive drugs and the most frequently prescribed drugs in Maine that have a Canadian equivalent. Using a reference rate based on the lowest cost option identified in the Canadian provinces, the report calculates a potential savings of $146.7 million for 72 drugs—of which over 98 percent is for brand drugs, rather than generics. Overall, the report found that many drugs patented in the US are not under patent in Canada, allowing for generic competition. However, there are not as many prescription drug products available in Canada that are equivalent to those available in the US.


Maine | Oct 19, 2022 | Report | Affordability

Maine’s Progress in Improving the Affordability of Small Business Health Insurance

The average health insurance premium for small business will fall by 0.8 percent from 2022 to 2023, the first such reduction since 2001, according to Health Affairs ForefrontThe state has taken several steps to reduce costs, including a 1332 State Innovation Waiver to merge the individual and small group market and extend reinsurance to small businesses purchasing through the merged market.


Maine | Apr 1, 2022 | Report | Health Costs

Governor Signs Bill to Improve Healthcare Affordability

New legislation signed by Maine’s governor will direct the state’s new Office of Affordable Health Care to take a targeted approach to improving affordability by studying existing affordability barriers and identifying policy solutions focused on making healthcare more affordable for Maine residents and small businesses, according to Consumers for Affordable Health Care. The legislation builds on previous legislation that established the Office and charged it with developing policy solutions to help rein in those high costs and improve efficiencies and coordination within the healthcare system, in addition to providing staff support to Maine’s Prescription Drug Affordability Board.


Maine | Feb 17, 2022 | News Story | Affordability

Maine to Merge Small Group and Individuals in Marketplace

The state will merge the Affordable Care Act insurance markets for individuals and small groups to create more stable pricing for health coverage, reports the Portland Press Herald. State officials say that Maine will be first in the nation to combine the two markets into a subsidized reinsurance program, with the goal of promoting more stability in the market. The merger will go into effect in 2023.


Maine | Jan 28, 2022 | News Story | Rural Healthcare Social Determinants of Health

Maine to Mail 125,000 Free COVID-19 Tests to Residents in Need

Maine’s governor announced the launch of a pilot project to mail 125,000 free COVID-19 tests directly to the homes of Maine residents most in need, according to the Office of the Governor. The state is partnering with the Rockefeller Foundation to provide 25,000 Maine households five at-home rapid tests for free. Households in rural ZIP codes and ZIP codes that are the most socially vulnerable, based the Centers for Disease Control and Prevention’s social vulnerability index, are eligible for the free tests. 


Maine | Jul 17, 2021 | News Story | Affordability

Office of Affordable Healthcare Becomes Law in Maine

A new law enacted in Maine establishes an independent, nonpartisan agency to attempt to control healthcare spending and improve access to quality care, reports the Associated Press. The office will analyze health data and make evidence-based policy recommendations to state lawmakers.


Maine | Jul 9, 2021 | News Story | Rural Healthcare

New Maine Law Recognizes Pharmacists as Healthcare Providers

Maine’s Governor signed LD 603 into law, which defines the practice of pharmacy as a provision of healthcare services and recognizes pharmacists as healthcare providers, according to the University of New England. Proponents of the law hope that it will provide more opportunities for pharmacists to provide healthcare services and expand greater access to care for patients, particularly in underserved rural communities.


Maine | Jul 7, 2021 | News Story | Drug Costs

Maine Caps Insulin Costs, Expands Medicaid Dental Coverage; Fails to Rein in Drug Prices

Healthcare advocates are celebrating legislative victories in the Maine Legislature, including a $35 cap on insulin costs and expanding Medicaid coverage for dental services to adults, reports The Press HeraldAdditionally, the legislature passed bills that extend Medicaid coverage twelve months postpartum and sets the minimum wage for direct care workers, such as those who provide home-based healthcare services, to 125 percent of the minimum wage. However, Governor Mills vetoed bills aiming to reduce prescription drug costs that would have outlawed price gouging and required drug manufacturers to justify price increases.


Maine | Apr 6, 2021 | News Story | Equity

Maine CDC Reestablishing Health Equity Office After Pandemic Reveals Stark Racial Disparity

Maine’s governor announced that it would be establishing an Office of Population Health Equity within the Maine Center for Disease Control and Prevention, reports Maine Public Radio. The mission of the office is to identify and address health disparities for certain populations. State health officials noted that there were plans to establish the Office before the pandemic and that the health disparities caused by the public health emergency highlighted the need for it. A health equity office had existed within the Maine CDC for years under different names, including the Office of Minority Health, but was dissolved in 2015.


Maine | Feb 18, 2021 | News Story | Rural Healthcare

MaineHealth Receives Grant for Rural Healthcare Research

Maine’s largest healthcare system, MaineHealth, received a $12.8 million dollar grant from the National Institutes of Health to study ways to reduce disparities in quality of care between rural and urban areas, reports the Portland Press HeraldThe grant will be used to fund several studies, including research on the use of telehealth and rural health outcomes, that aim to reduce rural health disparities in acute care settings. The funds will be used to develop a statewide network to address barriers in rural health, such as limited resources, access and expertise.


Maine | Oct 21, 2020 | Report | Rural Healthcare

Telehealth Use in Maine Increases, but Remains Relatively Low

Telehealth improved access to behavioral health and speech language pathology services in Maine, through usage still remained low, according to a study in the Journal of Rural Health. Telehealth usage increased to 0.28 percent of Maine’s population in 2016, up from 0.02 percent in 2008, based on data from Maine’s all-payers claims database. Telehealth usage varied by area: speech language pathology was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for more than 70 percent of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. The study identified provider shortages, broadband, and Medicare and commercial coverage policies as barriers to telehealth access and implementation in rural areas.


Maine | Sep 11, 2020 | News Story | Rural Healthcare

Grant Awarded to Fund Rural Healthcare Access Pilot Program

A $1.2 million grant from the U.S. Health Resources and Services Administration was awarded to fund a pilot program allowing paramedics to perform emergency care functions in order to improve healthcare access for rural citizens, reports Mainebiz. The grant will fund training for paramedics to perform urgent care skills under the direction of an emergency department via telemedicine, respond to acute 911 calls with local volunteer ambulance staff and pilot an emergency department physician consult program. The program works with community health centers in rural parts of the state to facilitate greater access to emergency services for Mainers who do not live near hospitals with emergency care services


Maine | Aug 6, 2020 | News Story | Health Costs Rural Healthcare Social Determinants of Health

A Volunteer Program in Maine to Transport Community Members to Healthcare Appointments

A volunteer program in Maine that provides transportation to patients who would otherwise not be able to attend their healthcare appointments may serve as a good model for other states, according to a study in Preventing Chronic Disease. The Kennebec Valley Community Action Program consists of 93 volunteer drivers, who are reimbursed for mileage with Medicare and Medicaid dollars, in addition to a staff of drivers and office staff members to address the need of rural residents without access to transportation. The program’s volunteer training and recruitment process and coordination between volunteers and patients provide a model for rural communities to fill in gaps in transportation access.


Maine | Jul 20, 2020 | News Story |

MaineCare Creates New Webpage on Telehealth Benefits

Maine’s Medicaid program, MaineCare, created a webpage that describes how its beneficiaries can access remote healthcare services. The website explains what types of services are available via telehealth, how to access telehealth and other remote care safely, as well as additional resources on telehealth and the COVID-19 pandemic.


Maine | Jul 1, 2020 | News Story

Maine Issues New Guidelines for Licensing Dental Therapists

Dental therapists are now able to obtain licenses to practice in Maine, reports the Pew Charitable Trusts. Dental therapists are midlevel providers who can perform preventative care and basic restorative procedures and can help address barriers to accessing oral health services. They have been used as effective tools in increasing access to care in rural areas and for patients on public insurance as well as improving oral health outcomes in other states. The Maine Board of Dental Practice’s ruling establishes education and licensure requirements so that schools can create training programs and enables dental therapists in other states to relocate and practice in Maine.


Maine | May 5, 2020 | News Story

Maine, N.H. Lead Report Card on Healthcare Price Transparency

Maine was one of two states to earn an 'A' grade from the Catalyst for Payment Reform (CPR) report card on healthcare price transparency, reports HealthLeaders Media. CPR and the Source on Healthcare Price and Competition, at the University of California Hastings College of Law, analyzed which states had advanced or implemented legislation promoting price transparency for healthcare consumers. The organizations focused on important components of price transparency laws, like whether the state mandates the creation of an APCD, makes healthcare price information available to consumers, and has a publicly accessible, mandated website.


Maine | Jun 18, 2019 | News Story

Maine Approves Telehealth Coverage Parity, Embraces RPM Programs

A new Maine law requires any private payer to cover any telehealth services that that would cover in person, based on six conditions outlined by the law. According to mHealth Intelligence, the bill also allows reimbursement for healthcare providers who use phone-based telehealth when scheduled telehealth services are technologically unavailable at the time of the scheduled telehealth service for an existing enrollee and the telephonic services are medically appropriate for the corresponding covered health care services. This new piece of legislation opens the door to more remote patient monitoring programs. 


Maine | Aug 7, 2018 | News Story

WalletHub Ranks Maine at Number 12 for Healthcare Overall

Maine is the nation's 12th best state for healthcare and No. 1 in terms of access, according to a survey done by WalletHub. According to WalletHub, access to healthcare was measured according to factors including the number of hospital beds per capita, average response time for emergency medical services, the average emergency-department wait time, physicians, nurse practitioners and urgent-care centers per capita, and the share of insured adults and children.


Maine | Aug 1, 2018 | Report

CMS Approves Maine's Health Insurance Waiver

CMS has approved Maine's Section 1332 waiver, allowing the state to move forward with changes to its ACA individual marketplace, according to Becker's Hospital Review. Maine's waiver will allow the state to remove the ACA's requirement for a single risk pool to implement its Maine Guaranteed Access Reinsurance Association.


Maine | Jul 9, 2018 | News Story | Rural Healthcare

New Law Expands Healthcare to Medically Underserved Areas

A new law in Maine will expand on existing programs to recruit and retain more primary healthcare providers and dentists in underserved parts of the state, according to The CountyAn existing income tax credit for eligible dentists who practice in underserved areas is set to expire in 2020, and Jackson’s measure will extend it until 2026. The new law also will provide the credit to more primary care professionals, such as physicians, nurse practitioners and physician assistants who practice in underserved areas. The credit will go to 10 providers in rural and underserved communities throughout the state, rather than the five allowed under the previous law.


Maine | Jun 5, 2018 | Blog | Drug Costs

Recent Drug Transparency Law Passed in Maine

Recent legislation in Maine directs the Maine Health Data Organization to report on the 25 most commonly prescribed drugs that have experienced large cost hikes, according to NASHP. The Maine Health Data Organization must establish a plan for data collection from manufacturers, and provide Maine lawmakers with an annual report on prescription drug prices beginning in April 2019.


Maine | Jun 5, 2018 | News Story

Rate Hikes Sought by Maine’s ACA Insurers Come in Lower Than Expected for 2019

Maine’s two leading providers of Affordable Care Act-compliant individual health insurance are requesting average rate increases of just over 9 percent in 2019, and smaller increases if a state-run reinsurance program is revived, according to the Portland Press Herald. Reasons for the proposed rate increases include the elimination of the individual mandate penalty and the resulting, anticipated decrease in younger, healthier Mainers purchasing individual ACA insurance in 2019. 


Maine | Mar 23, 2018 |

Central Maine Healthcare To Open Outpatient Facility In Topsham

According to Maine Public Radio, Central Maine Healthcare unveiled plans Thursday to open what it is calling a first-of-its-kind outpatient health center in the state. The Topsham Care Center is something between a hospital and an urgent care clinic. Officials say the model embraces a more contemporary approach to healthcare that will offer high quality services at a lower cost.


Maine | Jan 26, 2018 | News Story | Consolidation Rural Healthcare

How the Aetna-CVS Merger Could Affect Health Care in Rural Maine

According to Bangor Daily News, the pending merger of CVS Health and insurer Aetna could mean cheaper medications, more walk-in clinics and other benefits for Maine consumers. However, some observers fear it will undermine the tenuous stability of the state’s rural health system.


Maine | Oct 6, 2017 | News Story

Maine among top 10 states with 'highest-rated health insurance plans'

According to MaineBiz, the National Committee for Quality Assurance (NCQA)'s 2017-18 Health Insurance Plan Ratings ranks Maine as the third-best state in the country for the quality of its health insurance plans.


Maine | Sep 11, 2017 | News Story | Consolidation

Maine Health Network Pitches Unification as Lifeline for Local Hospitals

Additional public forums are continuing to give Maine and New Hampshire residents the chance to voice their opinion about a plan that would have MaineHealth hospitals and medical organizations governed by one statewide board of trustees, including Maine Medical Center in Portland and Southern Maine Health Care in Biddeford and Sanford, according to the Bangor Daily News.


Maine | Aug 2, 2017 | Blog | Health Costs

Why is Maine 5th in the U.S. for Healthcare Spending?

This Bangor Daily News opinion piece discusses the state of Maine's healthcare spending and how costs continue to rise at a faster-than-average rate. While lawmakers often stress the need to rein in healthcare spending, they have not settled on a long-term strategy to do so.


Maine | Jul 10, 2017 | News Story

New Maine Law Rewards Consumers Who Find Better Deals on Healthcare

Under a new Maine law, health insurers must compensate customers who find a better deal on many common medical services. According to the Bangor Daily News, the four categories of care considered “shoppable” are physical and occupational therapy, radiology and imaging, laboratory services and infusion therapy. 


Maine | Jun 27, 2017 | News Story

Maine Legislature Passes Gift Ban Bill

According to Policy and Medicine, the Maine Legislature recently passed a bill amending the Maine Pharmacy Act. The bill prohibits a person engaged in the manufacture of prescription drugs or a person who buys prescription drugs for resale and distribution to persons other than consumers from giving a gift to an individual who is licensed, registered or otherwise authorized in the appropriate jurisdiction to prescribe and administer drugs in the course of that individual's professional practice.


Maine | May 17, 2017 | News Story

Sufficient Money Makes Maine’s High-Risk Pool Successful

High-risk pools have been touted as a strategy to hold down premiums for those outside the high-risk pool. A number of states have attempted high-risk pools with mixed results. Maine has been more successful than most due to a key ingredient—sufficient funding—according to Kaiser Health News. 


Maine | Sep 28, 2016 | Report

High Value Healthcare Collaborative: Optimizing Treatment of Septicemia and Sepsis with Bundled Care

The High Value Healthcare Collaborative—a provider network focused on improving healthcare value through data and collaboration—won an award from the Center for Medicare and Medicaid Innovation to implement a sepsis bundled payment in 23 facilities as a part of the two-year improvement project. The overall goal was to improve inpatient acute care bundle adherence for severe sepsis and/or septic shock by 5 percent over three years to achieve a $12.4 million cost savings to Medicare. By 2014 the project reduced costs by 7.7 percent and sub-acute nursing care by 7 percent.



Maine | Apr 19, 2016 | Report | Health Costs

New Report Points to Price Variations in Maine

Research comparing prices for common medical procedures between thirty-three hospitals has exposed substantial price variation between facilities, according to the Maine Heritage Policy Center. Little variation in prices can be attributed to geographic location or hospital size.


Maine | Mar 31, 2016 | Report | Medical Harm

2016 Annual Report of Healthcare Associated Infections

Maine hospitals continue to show progress in reducing the incidence of healthcare-associated infections (HAIs), although opportunities for improvement remain, according to the Maine Quality Forum. Recommendations made by the Maine Quality Forum include reviewing the HAI quality measures, developing a regional conference to focus attention on HAI prevention and expanding antibiotic stewardship efforts among others.


Maine | Mar 23, 2016 | News Story

Maine’s Largest Obamacare Insurer to Raise Rates

Bangor Daily News: Maine Community Health Options plans to raise premiums and draw on reserves after suffering a loss of $31 million in 2015. The insurer has also set aside $43 million in reserves to cover projected losses for 2016. MCHO was the only co-op in the country to turn a profit in 2014, its first year of operations. Its membership has grown dramatically since then; hospital and medical payments grew by 138 percent last year, compared to a 71 percent growth in revenue from premiums. To deal with the losses, MCHO plans to cut administrative costs and raise rates, according to MCHO spokesman Michael Gendreau.


Maine | Dec 15, 2015 | Report

DHHS Newly Created SIM Core Measures Dashboard

Maine released a SIM Core Measures dashboard that shows trends on core healthcare measures selected by a statewide group of healthcare leaders. The state also releases an annual report analyzing the data. Compared to the control group, one of MaineCare’s Health Homes succeeded in decreasing non-emergent emergency department use and a smaller percent increase in facility outpatient clinic costs, according to the first annual report. However, the population also faced increased care fragmentation, decreased pediatric access to primary care, and mixed results relating to provider engagement of patients. The MaineCare Behavioral Health Homes showed notable cost avoidance compared to the control group, and differed in quality only by the level of fragmentation in care. While the experimental group’s fragmentation stayed stagnant, the control group experienced significantly less fragmentation, which benefits the consumer.


Maine | Nov 2, 2015 | News Story | Price Transparency

New Website Compares Cost, Quality of Healthcare in Maine

Consumers in Maine have known for some time that there’s a lot of information about healthcare. However, it has often been difficult to use available data to make meaningful decisions about the quality and price of various medical procedures. The quest for meaningful comparisons became easier last week. The Maine Health Data Organization, or MHDO, launched a new website, CompareMaine.org


Maine | May 5, 2015 | News Story

Some Maine Smokers Facing High Surcharge on Health Plans

Portland Press Herald: The Maine legislature failed to override a veto by Gov. LePage of a bill that would have capped the extra amounts some health insurance plans charge for smokers. Legislators were worried that such a bill would make coverage too costly for consumers who smoke in Maine.


Maine | Mar 1, 2015 | News Story

Maine Hospitals Look to Local Fish and Vegetables to Improve Health and Patient Satisfaction

Portland Press HeraldHospitals in Maine have begun feeding patients locally sourced, healthy foods as an effort to increase patient experience. At least ten hospitals across the state have been working with local farms and Maine fisherman to create healthy menus and attract patients through better food.


Maine | Mar 19, 2014 | News Story

In Healthcare, What Makes Maine Different?

Los Angeles Times: Maine is one of the healthiest states in the U.S. as a result of a highly personalized, collaborative medical system created in the 1970s. This article examines the system of community-based, coordinated care in Maine  and its positive impact on the quality and value of care that residents receive.