The LePage administration has cut off funding for the last remaining state-funded groups that are responsible for tackling local health problems and ensuring local areas can respond to public health emergencies such as disease outbreaks.
The end of funding for public health district coordinating councils in Maine’s nine public health districts comes less than a year after the LePage administration dissolved a set of 27 local public health groups, known as Healthy Maine Partnerships, and shifted some of their funding and responsibilities to the district councils.
The district coordinating councils received notice Friday, July 21, from the Maine Department of Health and Human Services that their funding had ended as of June 30. Beyond informing them of the end of funding three weeks after it had already ended, state public health officials haven’t indicated whether or how the district coordinating councils should move forward.
The district councils are regional coalitions of health care providers, municipal governments, law enforcement agencies, schools and others that have tackled health challenges such as obesity, addiction, tobacco use and oral health in their regions. Without funding for the district councils, it’s unclear if Maine DHHS expects to maintain local public health infrastructure across the state.
“Due to the short notice of this legislative directive and the need to find reductions within the current Fiscal Year, the Department is still pursuing alternative approaches to retain core public health infrastructure capacity and functions,” Sheryl Peavey and Chris Pezzullo, who co-lead the Maine Center for Disease Control and Prevention, wrote to district coordinating council leaders in a notice sent Wednesday afternoon.
A spokeswoman for Maine DHHS, of which the Center for Disease Control is a part, sent Peavey and Pezzullo’s statement to the BDN in response to detailed questions. The spokeswoman, Samantha Edwards, didn’t respond to questions about DHHS’ plans to support local public health efforts in the future or if the department believed the public health work could continue without state funding.
Funding for the public health district coordinating councils is ending as the result of $5 million per year in public health funding cuts in the new, two-year state budget that Gov. Paul LePage signed into law July 4.
Instead of paying for public health efforts, the $5 million will pay for services through the state’s Medicaid program, lowering the amount of state tax dollars needed to pay for that program, which used $800 million in state taxpayer funds last year.
The $5 million comes from a pot of money Maine receives each year because of its participation in the Tobacco Master Settlement Agreement with the nation’s largest tobacco companies. The state has traditionally used much of that money for anti-smoking and other public health efforts.
“The Department recognizes this legislative directive will require significant changes to some programs, and result in reductions to numerous contracts held by the CDC,” Peavey and Pezzullo wrote.
While the notice from the LePage administration attributed the cuts to action by the state Legislature, the cuts would have been deeper if the budget proposed by Gov. Paul LePage in January passed in its original form. His initial proposal would have sliced about $10 million per year from public health budgets, instead of the $5 million in annual cuts included in the final budget.
“I think one of the principles in public health is that success in public health is often silent, and that’s often when cuts to public health are made,” said Dora Anne Mills, vice president for clinical affairs at the University of New England and former director of the Maine CDC. “When there is a crisis or a public health problem that arises, that’s when people suddenly miss what was previously cut.”
Rep. Drew Gattine, D-Westbrook, the House chair of the Legislature’s appropriations committee, said the cuts came as the result of a budget compromise through which lawmakers rolled back many other cuts to health and social services programs proposed by LePage.
Lawmakers didn’t specify which programs the Maine CDC would cut as a result of the $5 million in cuts, Gattine said. That’s why the elimination of district coordinating council funding, as well as the elimination of state funding for 15 student health centers in schools, has taken many by surprise.
Among those surprised was Portland Public Schools Superintendent Xavier Botana.
On Wednesday, Botana learned that the four student health centers in Portland’s public schools were losing funding. Through a contract with Greater Portland Health, the centers provided an array of health and mental health services to around 1,000 students last year, ranging from physicals and dental work to immunizations and help to students trying to quit smoking.
The centers serve students regardless of their insurance or financial status
“If the services were to disappear it would limit access to medical care for a significant number of students who depend on these services to get important health care needs met,” Botana said.
There are also student health centers at schools in Brewer, Calais, Lewiston, Readfield, Topsham and Norway, according to Edwards with DHHS.
Cuts in two stages
The district coordinating councils have partially stood in for the local public health infrastructure most other states rely on county-level public health departments to provide, said Kristen Dow, chronic disease prevention program manager for the City of Portland, which is part of the Cumberland County public health district.
“It’s worrisome what the plan is moving forward for that,” she said.
Maine has no county-level public health departments, and the only two municipal public health departments are in Portland and Bangor.
The Maine CDC continues to employ staff members who serve as public health liaisons in eight public health districts that have lost funding for their coordinating councils. In the state’s ninth public health district, which covers areas controlled by the four federally recognized tribes in Maine, the state hasn’t yet indicated whether it will renew funding for a contracted public health liaison, said Kristi Ricker, the liaison to the tribal public health district.
When the LePage administration ended the 27 more local Healthy Maine Partnerships last year, it transferred much of their work and some of their funding to the nine district coordinating councils that each covered larger areas.
In advance of the change last year, the Maine Center for Disease Control and Prevention said in a news release justifying the Healthy Maine Partnerships’ dissolution that the district coordinating councils “comprise the statewide public health infrastructure.”
“That’s why we are investing in staffing support to assist the [district coordinating councils] and strengthen their roles as leaders of public health and their respective districts,” then-CDC Director Ken Albert said in the news release.
The state spent $1.45 million total on the district coordinating councils last year — $160,000 each — enough for each council to hire a coordinator, set health priorities for their local areas, create plans, and start dispensing grants to local organizations to tackle those priorities.
“We never had a lot of time,” said Dow. “We never had a full year to work on this, and then it was pulled out from under us.”
In Cumberland County, district council members identified four health priority areas — substance use prevention, healthy weight promotion, oral health improvement, and improvements to medical and mental health care for young children — and awarded contracts to local organizations to start carrying out the work.
The organizations hired for anti-obesity efforts, for example, planned to work with local governments on adopting policies aimed at making streets safer for walking and biking, and with local businesses on encouraging employees to walk and bike to work.
“A lot of it was assessing what’s out there and getting a feel for that in the first year, so we can hopefully take what we learn and next year move the needle and dig into those areas,” said Dow. “Now, that work stops.”
The district coordinating councils expected a funding increase, to $180,000, for the state fiscal year that started July 1, and councils were working with state officials on finalizing those agreements — until they received notice last Friday that funding had ended, said Jamie Comstock, health promotion manager for Bangor Public Health and Community Services, part of the Penquis public health district that covers Penobscot and Piscataquis counties.
“Since 2007, we’ve worked to build this system,” Comstock said. “We’ve watched good people with expertise in public health lose jobs, and it’s been really sad to see all of that crumble.”
BDN reporter Jake Bleiberg contributed to this report. Maine Focus is a journalism and community engagement initiative at the Bangor Daily News. Questions? Write to mainefocus@bangordailynews.com.