Friday marks the last day of business for more than two dozen small, regional coalitions that have been responsible for promoting public health in their local areas and played a part in responding to public health emergencies.
The end of the state’s 27 Healthy Maine Partnerships comes as the Maine Department of Health and Human Services reworks the way it handles substance use, tobacco and chronic disease prevention, but with little public explanation of the changes it’s making.
For more than a decade, the Healthy Maine Partnerships have combined hospitals, local health care providers, schools, municipal health departments and other organizations into regional coalitions that performed much of the work a county-level public health department would.
They have helped respond to public health emergencies and undertaken proactive public health efforts — collaborating with retailers to crack down on youth tobacco sales, helping towns and cities craft and implement smoke-free policies and increase access to nutritious food, and coordinating with landlords to make their housing smoke free.
Sept. 30 marks the last day of funding for the 27 partnerships. Going forward DHHS will instead rely on five organizations that will each have statewide responsibility for coordinating a specific public health effort, such as obesity, smoking and substance use prevention.
The department has yet to finalize contracts with any organization. Some partnerships have already shut down, and others have laid off some employees.
“We’ve been winding down,” said Liz Blackwell-Moore, a substance abuse prevention coordinator with the Opportunity Alliance in South Portland, which is the lead organization for two Portland-area Healthy Maine Partnerships. “We didn’t want to start something we didn’t know we could continue.”
From regions to themes
The LePage administration is undoing a structure created after years of statewide discussion and planning.
Before the first generation of Healthy Maine Partnerships that formed in 2001, the state lacked any structure that ensured every region of the state could take proactive steps to improve public health and help out with the response to a public health emergency. Unlike most other states, Maine doesn’t have county-level public health departments that would normally fill those roles.
The Healthy Maine Partnerships in their current form, which dates back to 2008, are the result of multiple years of planning by a 40-member public health work group that met from 2005 to 2007. The work group proposed the Healthy Maine Partnerships arrangement following those meetings, and the Legislature incorporated the group’s recommendations into law in 2008.
The partnerships were funded not with tax dollars but with money the state receives each year through its participation in the Tobacco Master Settlement Agreement with the nation’s largest tobacco companies. In their early years, the partnerships were responsible for thousands of policy and environmental changes, such as establishing walking trails and banning unhealthy snacks from vending machines, researchers from the Maine Center for Public Health showed in a 2009 study.
Now, the Maine Center for Disease Control and Prevention within DHHS is turning a regional approach into a thematic one.
Instead of contracting with each local partnership, it plans to contract with five large organizations, each of which will tackle one of five public health domains: substance use prevention, tobacco use and exposure, obesity prevention, youth engagement and empowerment, and health communications. Each organization will, in turn, contract with local groups to carry out the work.
A ‘fundamental change’
DHHS and the LePage administration are reworking Maine’s public health system with little public communication and with minimal legislative involvement, although Healthy Maine Partnerships and funding for them are written into state law.
Samantha Edwards, a Maine DHHS spokeswoman, didn’t respond to questions from the BDN about changes to how the state will deliver public health services. Officials from DHHS, which controls more than a third of the state budget, haven’t responded to BDN questions since early summer.
In a March press release, Commissioner Mary Mayhew said the state needed to change the way it tackles public health. “We must move Maine’s public health system to one that leads the development of strategies that focus on prevention and wellness, builds diverse partnerships, and effectively integrates with clinical health,” she said. “Public health must be more flexible and able to address emerging needs by taking swift and appropriate action.”
The partnerships have largely been in a state of flux throughout the LePage administration. In 2012, the Legislature cut funding for the coalitions to $4.7 million from $7.5 million. And the LePage administration in 2015 proposed using much of the partnerships’ funding source, the Fund for a Healthy Maine, for other purposes.
Healthy Maine Partnerships’ staff members contacted by the BDN said DHHS has communicated little with them about the overhaul to a system that has been in place for years. The partnerships have typically operated on five-year funding cycles, and they expected to see the state issue a new request for proposals late last year that would have allowed them to renew their funding. But the call for proposals never came.
Lawmakers have also sought information recently on the status of new statewide contracts with private organizations to replace the work of the partnerships. But the LePage administration hasn’t shared the information with them, either.
“Because our staff has been working diligently on the budget every day all summer, and we are now entering crunch time, we will be unable to provide these detailed answers by the deadline you have proposed,” Gov. Paul LePage wrote on Sept. 13 in response to questions submitted by the Legislature’s appropriations committee a day earlier on the status of Healthy Maine Partnerships’ contracts and a variety of other public health topics.
“If you would prefer to wait for our comprehensive responses to your questions prior to the seating of the 128th Legislature, perhaps you can find a way to extend the timeline in the Maine Constitution for submitting the budget,” LePage continued. “Then the administration’s staff can set aside its vitally important and all-consuming work on the budget to work on the lengthy and complete responses your questions necessitate.”
Rep. Drew Gattine, a Westbrook Democrat who co-leads the health and human services committee, has worked with three previous governors in different capacities and said the unwillingness of the LePage administration to communicate with the Legislature is a “fundamental change.”
“It’s shocking to think that the department would make these changes without a higher level of engagement with the Legislature or the public,” Gattine said.
What we know
The Maine CDC has chosen the winners for three statewide contracts so far through a competitive bidding process. It chose a fourth contractor without soliciting competitive bids.
The state is still soliciting proposals for a fifth public health function, which the agency has labeled “Mass-Reach Health Communications for Prevention Services.”
Here’s what we know, based on interviews and documents obtained by the BDN:
— MaineHealth, the parent organization of Portland’s Maine Medical Center, won a $2.3-million contract to prevent tobacco use. One objective in the MaineHealth contract is to reduce the number of kids exposed to secondhand smoke at home by 20 percent; another is to reduce the adult smoking rate by 10 percent.
— The University of New England in Biddeford won the substance use prevention contract, worth $2.47 million. UNE plans to fund a variety of local efforts aimed at reducing drinking and the use of opioids, prescription drugs and marijuana among young people.
— The Opportunity Alliance in South Portland won a $1.18-million contract to boost youth engagement, which will involve creating a statewide network of “youth-adult partnerships” that work on improving resilience and reducing drug use.
— “Let’s Go!,” a program of the Barbara Bush Children’s Hospital at Maine Medical Center, won a $1.6-million award to address obesity without bidding for it competitively. It plans to increase the number of schools and early childhood programs involved with the “Let’s Go!” anti-obesity program and work on other efforts, such as limiting the availability of unhealthy foods in schools.
The Maine CDC’s decision to award the obesity contract without competitive bidding raised a red flag for Gattine. There is a “very, very, very” narrow set of circumstances under which DHHS can enter into contracts without going out to bid, he said.
The agency argued “Let’s Go!” should get the sole-source contract because the program is uniquely qualified to undertake a statewide obesity prevention campaign. “‘Let’s Go!’ is the single entity that maintains an infrastructure to support immediate access into the respective settings. Further, there is brand recognition of Let’s Go! that many stakeholders both recognize and ‘buy-into,’ from public health to healthcare to education and beyond,” DHHS wrote on the form it must file when it forgoes competitive bidding.
The state is still seeking proposals for the health communications function. According to its request for proposals, the state is looking for a vendor to manage public awareness campaigns that support the work MaineHealth and the University of New England are taking on.
Since the state hasn’t finalized any contract, the exact amount of funding for each organization may change. Once approved, the five organizations will begin awarding their own funds to smaller groups, which could include the former Healthy Maine Partnerships but likely not all of them.
The University of New England plans to award 75 percent of the funds it receives to one or more organizations in each of Maine’s nine public health districts. Tory Rogers, director of “Let’s Go!,” said she plans to distribute more than half of the program’s award to subcontractors.
MaineHealth will subcontract out services using “the vast majority” of its funds, said Kenneth Lewis, director of the MaineHealth Center for Tobacco Independence. Nicole Manganelli, director of the Maine Youth Action Network of the Opportunity Alliance, said less than half of its money will go to subcontracted, local groups.
The new contracts are annual, where the partnerships received funding on a five-year cycle. Several Healthy Maine Partnerships’ staff members said that even if their organizations are awarded subgrants, they won’t be able to plan for long-term work because they won’t know if they have more than a year left.
Healthy Maine Partnerships’ staff members reached by the BDN said they were dismayed by the lack of communication about changes to a long-term program that have resulted in layoffs and uncertainty within their communities. In addition to a lapse in services, they said the biggest loss may be the social capital and community roots their organizations have built up over the past decade, especially in rural areas.
“The HMP name was known throughout the state as a trusted source, and dismantling that is a shame,” said Becky Smith, government relations director for the American Heart Association and member of Friends of the Fund for a Healthy Maine. “The work may continue, but it may be hard to rebuild that name recognition and the trust that the HMP engendered, especially in the rural parts of the state.”
The regional coalitions will no longer be able to use the Healthy Maine Partnerships brand, even if they continue some of their work, coalition staff members said.
“These are not faceless people,” said Julie Daigle, the director of Power of Prevention, a partnership in Fort Kent. “They’re members of your community. You’re letting down actual people. There’s nothing theoretical about this.”
Daigle lost her job Friday when her organization’s contract with the state ran out.
The new public health infrastructure will revolve around Maine’s nine public health districts, instead of the smaller coverage areas that the 27 regional coalitions oversaw.
This is “a total step down in service from the past,” said one partnership staff member who requested anonymity out of fear of retribution. “Just physically, it will be hard for one person to get around the whole [public health] district.”
Maine Focus is a journalism and community engagement initiative at the Bangor Daily News.