1. Fund for a Healthy Maine:
Creating Opportunity for Greater Health and
Lowering Costs for Everyone

2. The Challenge
75% of health care costs are
the result of chronic disease.
(CDC)

3. The Challenge
Maine spends approximately $8 billion
on health care costs each year.
The Fund for a Healthy Maine, Maine’s
only source of State funds for
prevention, accounts for only .7% of
Maine’s total health care expenditure.

4. The Challenge
Maine’s Current Health Cost Investment Structure* Investing in Prevention Reduces Overall Health Costs
Prevention
Prevention
Pre-Disease
Treatment
Pre-
Disease
Treatment
Care for Disease
Care for
Disease
Prevention
Greater investment in preventive medicine and education helps to dramatically reduce chronic
disease, thus decreasing long-term treatment costs to Maine and its residents.
*Charts represent the total funding to each health-related function.

5. Overview of the FHM
• The Fund for a Healthy Maine (FHM) was created
by the Maine Legislature in 1999 to receive and
disburse Maine’s annual tobacco settlement
payments. Maine participated in the national tobacco
settlement because many Maine people have suffered
disease and death as a result of tobacco use encouraged by
the deceptive practices of the tobacco industry.
• The Fund for a Healthy Maine is not taxpayer
dollars. Because of its special source, the FHM has a
special purpose – to prevent disease and promote good
health among Maine children and adults. The FHM is meant
to ―supplement, not supplant‖ existing dollars!

6. Overview of FHM (cont.)
• FHM revenue is not part of Maine’s General Fund
account. It originates in the FHM account and only ends up
in the General Fund if lawmakers divert it there. FHM
program allocations are made directly from the FHM account
and do not pass through the General Fund.
• By statute, allocations from the FHM must be used to
supplement, not supplant, appropriations from the
General Fund. It was intended that the FHM be used for
new and expanded programs. The FHM was not intended to
be used to balance the state budget or spent on non-health-
related programs.

7. Allocation Since Inception: The Vision
90%
Program
10% FHM -Substance
Abuse Spending
Trust Fund Prevention & Treatment
-Prescription
Drugs for the Elderly
-Child Care
-Oral Health
- School Health Program
-Tobacco Prevention, Treatment & Control
The Vision:
-Home Visitation
New and
-MaineCare
Expanded Health
Programs

8. Overview of FHM (cont.)
• Unfortunately, these provisions have been
ignored in the past and the FHM has lost
17.1% of its resources ($126.8 million) to the
General Fund – a significant missed investment in
getting and keeping Maine people healthy.

9. Allocation Since Inception: The Reality
17.1% Diverted 82.9% Program
to General Fund -Child Care Spending
(trust fund abolished) (allocated or reserved)
-Oral Health
-Home Visitation
-Prescription Drugs
-Tobacco Prevention and Treatment
-Substance Abuse Prevention & Treatment
-School Health Program
-MaineCare
The Reality:
$126.8 million diverted or
approved for diversion
through FY 13

10. Overview of FHM (cont.)
• The Maine Legislature decides how FHM
dollars are allocated within the eight FHM
categories. FHM allocations and diversions are
currently decided as part of the state’s overall
budget process.

11. FHM Financial Present and Future
MSA payments continue in perpetuity

12. Purpose of the FHM
FHM funds should not replace General Fund
allocations to MaineCare.
WHY?
BY LAW: FHM funds must be used to ―supplement, not supplant‖ General Fund
spending.
FUNDING PROVIDED: FHM monies already go to fund health care initiatives for
children and parents.
ORIGINAL INTENT: Founders believed the FHM should be used primarily to prevent
disease, improve health status, and reduce future health costs.
FISCAL RESPONSIBILITY: 75% of health care costs are the result of chronic disease,
and most chronic disease is preventable.
The best way to get health care costs under control is
to PREVENT chronic disease, not pay for it after the fact.

13. FHM Impact-Once in a Lifetime Opportunity
The success of FHM programs
will directly affect Maine’s ability
to stabilize health costs and
their impact on Maine
businesses, individuals, and the
state budget.

14. Purpose of the FHM
• Preventing chronic disease
• Improving health status
• Reducing future health costs

15. FHM Programs: Budget Allocations by Program
in FY 2012
Family Planning Home Visitation School Breakfast Program Transfer to
$401,430 $2,653,383 $213,720 the
0.8% 5.1% 0.4% General
Substance Abuse Fund
$3,105,972 $1,375,000
6.0% 2.7%
Dirigo Health Program
$1,161,647
2.2%
Oral and Dental Health
$874,203
1.7%
Tobacco Prevention and
Control*
$14,180,059
Medicaid Initiatives 27.4%
$7,876,677
15.2%
Attorney General
Health Education Centers Child Care $111,840
$100,353 $5,296,816 0.2%
0.2% 10.2%
Immunizations Prescription Drugs for the
$1,078,884 Elderly and Disabled **
2.1% $11,934,230
23.1%
Public Health Infrastructure
$1,366,802
*A total of $9,358,839 (66%) spent directly on tobacco prevention, treatment, and control. 2.6%
**Includes $4,500,000 in Racino funds.
***Does not include $1,891,952 used to pay back FY 11 cash advance. Total Allocations: $51,731,016***

16. Racino Funds:
Drugs for the Elderly and Disabled
10% of net slot machine income must be credited to the FHM each year to be used only for prescription drugs for the elderly
(see 8 MSRA Sec. 1036, 22 MSRA Sec. 1511, 6 (E))

17. FHM Programs: Overview
The Legislature established eight categories of
allowable health program spending:
o Smoking prevention, cessation and control activities, including, but not
limited to, reducing smoking among the children of the State;
o Prenatal and young children's care, including home visits and support for
parents of children from birth to 6 years of age;
o Child care for children up to 15 years of age, including after-school care;
o Health care for children and adults, maximizing to the extent possible federal
matching funds;
o Prescription drugs for adults who are elderly or disabled, maximizing to the
extent possible federal matching funds;
o Dental and oral health care to low-income persons who lack adequate dental
coverage;
o Substance abuse prevention and treatment; and
o Comprehensive school health programs, including school-based health
centers.

18. FHM Programs: Tobacco
• High school smoking declined by 64% between 1997
and 2007. In that same period, middle school smoking
has declined by 73%.
• Maine’s Tobacco HelpLine has served over 75,000
Maine residents since its inception in 2001.
• The Healthy Maine Partnerships (HMPs) are engaged in
over 800 health initiatives across the state to change
local attitudes about tobacco use, and increase physical
activity and healthy eating. The HMPs have enlisted
2,300 volunteer coalition members throughout Maine.

19. FHM Programs: Tobacco and
Healthy Maine Partnerships
―I'm known as Vegas girl. I quit smoking
in January, the day before I flew to Vegas.
I smoked for approximately 32 years. I,
for the first time in years, had a very
healthy winter with no bronchitis or
sinus infections and (saved tons of
money)! If it wasn't for all the
phenomenal support and weekly letters
from Healthy Androscoggin I feel I would
never have been so successful. The
support was amazing and I am so proud
of me and Healthy Androscoggin.―
—Michele Wagner, 48 of Lewiston,
was a participant of Healthy Androscoggin’s (a
Healthy Maine Partnership) Quit & Win
Program. Michelle quit smoking to regain her
singing voice, which she was able to do last
year, literally singing her song of praise to the
staff.

20. FHM Programs: Child Care
• About 3,000 children, ages birth – 12, currently receive child care,
Head Start, or after-school programs each year.
• Nearly 2,500 children, ages 12 - 15, participate in a range of
recreational, cultural, academic, and arts programs after school and
in the summer.
• Child care programs promote preventative health care that
provides families with the opportunity to identify and treat health
problems before complication occur. Programs, like Head Start,
collaborate with families, staff and health professionals to identify
child health and development concerns and link children and
families to an ongoing source of continuous, accessible health care.

21. FHM Programs: Child Care
Head Start
• 100% of enrolled pregnant women received prenatal and postpartum health
care, education on fetal development and benefits of breastfeeding. Over 63%
of pregnant women received mental health interventions. The majority of
pregnant women were enrolled in program during their 1st trimester.
• Over 98% of children had a medical home by the end of the enrollment year.
• Over 77% of children received all medical screenings. Of those who were
identified as needing medical treatment almost 98% received treatment.
• Almost 79% of children had a dental home at the end of the program year;
76% completed dental exams. Of those needing dental treatment 71%
received treatment.
• Almost 97% of children were up-to-date on all immunizations or had received
all immunizations possible by the end of the enrollment year.

22. FHM Programs: Child Care
―I was homeless and needed
care for my 4 year old son.
Through assistance from the
Fund for a Healthy Maine, my
son received full-day Head Start
service, including nutritious
meals. Staff also helped me get
the dental and health care he
needed.
The supports gave me the
opportunity to look for a job. I
found employment and got an
apartment. We are happy and
excited to be together in our
own home.‖
-Roxanne,
Head Start parent

23. FHM Programs: Substance Abuse
• The overall lifetime alcohol use rate among Maine’s 6th to 12th
grade students had dropped consistently over the past decade-from
70.7% in 1995 to 44.3% in 2008.
• Maine’s Higher Education Alcohol Prevention Partnership (HEAPP)
is a partnership between Maine’s colleges and universities and the
Maine Office of Substance Abuse to bring about long-term,
systemic change in how high risk drinking and other substance
abuse issues are addressed at the state and local levels. From 2000
to 2010 the number of colleges and universities participating has
increased from 4 to 18.

24. FHM Programs: Substance Abuse
―The Sebasticook Valley Healthy
Communities Coalition has developed
Youth Advocacy Programs in Pittsfield
and Newport (a total of 4 groups). These
middle school and high school programs
work together to promote physical
activity and nutrition; and prevent
substance abuse and tobacco use. A
couple of examples: we held a sledding
event this past winter and we also held
healthy youth activities this summer at
the fair in Pittsfield. Both had great
turnouts.‖
-Kristen Webster
Substance Abuse Coordinator, Pittsfield

25. FHM Programs: Substance Abuse
―One of its current residents, an 18 year-old
young man, grew up in an alcoholic and
drug abusing family. He began to use drugs
at age 9. By 16 he had moved out of his
home, dropped out of school and was in
trouble with the law. Day One gave him a
chance to become the kind of person he
wanted to be. He is now sober and healthy,
has forged caring relationships and is
working toward his GED. He will graduate
from the program in one month.‖
-Rebecca Howe,
Day One

26. FHM Programs: School Based Health Centers
• Maine has 25 School-Based Health Centers (SBHC) in 16 communities. SBHCs deliver
primary care medical services and preventive health services to students whose parents have
enrolled them in a SBHC. Some SBHCs also provide behavioral health and/or oral health
services.
• In the 2009/2010 school year 7,121 students were enrolled in SBHCs. There were 13,108
encounters including acute care, behavioral health, oral health and preventive health visits.
More than one third (35%) of students who smoke and were seen at a SBHC reported that
they reduced their smoking or quit smoking as a result of their visit.
• More than half (56%) the SBHC users who have asthma have an up-to-date asthma plan on
file, up from 31% the previous school year.
• More than three-quarters (76%) of SBHC users who were identified as being depressed
were done so using an evidence-based screening tool.
• Close to half (42%) of medical encounters were for a preventive health purpose (e.g.,
immunization, health counseling, physical exam).

27. FHM Program: School Based Health Centers
―The Mission of the Maine Assembly on School-
Based Health Care (MeASBHC) is to ensure that
all Maine Students have access to healthcare
through advocacy, promotion, support and
sustainability of school-based health centers at
the local, state and national levels.
School-Based Health Centers help keep children
in school, increasing their chances of success as
students and as citizens. The MeASBHC
advocates that the health needs of students be
addressed in the place they spend the most
time, at school.
Student-centered care creates a safe,
comfortable and confidential environment where
adolescents receive the health care they need.
The FHM helps support some of Maine’s SBHCs
as well as other health programs across the
state.‖
--Cindy Flye, President, Maine Assembly on
School-Based Health Care

28. FHM Programs: Oral Health
• The Dental Subsidy Program supported 11 community based
agencies in providing over 33,700 dental services to nearly
18,400 patients in 15 locations during the 2010 fiscal year.
• 25% of Maine dentists participate in the Donated Dental
Services Program providing free services to qualified disabled
and elderly individuals through a FHM paid coordinator
• The Dental Education Loan & Repayment Program has
awarded 25 loans to dental students who have or will return
to Maine and 15 loan repayment awards to dentists practicing
in underserved areas and who see all patients.

29. FHM Programs: Oral Health
―The case management
services made possible
through these funds
continues to be a vital part
of the Children’s Oral
―The Washington County Health Program. . . We are
Oral Health Task Force able to have children who
wouldn’t have happened receive urgent referrals,
without these funds.‖ indicating pain and/or
-Sherri Camick, RDH abscess, seen almost
Dental hygienist, Eastport
immediately.‖
-Kathy Martin, RHD, MS
Director, City of Portland
Children’s Oral Health Program

30. FHM Programs: Teen Pregnancy Prevention
• Maine's teen pregnancy rate decreased by 48% between
1988 and 2005, one of the most dramatic decreases in
the nation. Maine's rates of teen pregnancy and teen
birth are among the lowest in the nation.
• The percentage of high school students who have ever
had sexual intercourse has declined from 52% in 1997 to
45% in 2007.
• Among high school students who are sexually active, the
percentage who used a condom during their last sexual
intercourse has increased significantly from 51% in 1997
to 59% in 2007. The percentage who used birth control
pills has increased from 30% in 1997 to 41% in 2007.

31. FHM Programs: Teen Pregnancy Prevention
―I am grateful that Glenn
(PPNNE Educator) could lead
―You really opened my eyes
us to have such a positive
about relationships and
outlook especially with my
what I want. I hope you
foster kids’ background and
continue to help us
experiences, and that they
students."
came away feeling better
about themselves and - 8th Grade student,
Memorial Middle School, So. Portland
optimistic about their
future. Thank you.‖
- Parent of youth participant

32. FHM Programs: Home Visitation
• 72% of participants whose children were exposed to secondhand smoke
reduced or eliminated their child's exposure.
• Children in the program are routinely screened for developmental
delays. Seven percent of those screened were referred for further evaluation,
and as a result 72 percent of those children referred through home visiting
received needed services to address developmental issues.
• Due to the focus on improving health outcomes for children, 99.5% of
children had a primary care provider, 98% were up-to-date on well-child
exams, 95% had health insurance and 93% were up-to-date on childhood
immunizations.
• To help families increase self-sufficiency and access needed resources,
program staff partner with and make a significant number of referrals to
community resources. Maine Families staff made more than 23,000 referrals
on behalf of families this past year.

33. FHM Programs: Home Visitation
"As a new parent, the deluge of information
you are left to sort through in the first days,
weeks, and months of your child's life is
overwhelming at best. The KVCAP Healthy
Families program is a valuable resource for any
family facing this challenge for the first
time. From day one my son, Logan, was not
so easy to console. He was very colicky and I
often felt helpless as to how to comfort my
son. In addition to providing the most up to
date and credible information on health,
safety, and development, my representative
showed me educational activities to enrich and
encourage the mental and physical growth of
my son. By keeping me informed and providing
support, KVCAP Healthy Families helped me
become the best parent I could be.‖
-Misty Dostie
Parent, Augusta

34. FHM Programs: MaineCare
• The Fund for Healthy Maine provides critical health care coverage
through the MaineCare program for thousands of low-income
Maine families who would otherwise be unable to afford health
insurance for themselves and their children.
• Coverage for children is a wise investment. Children without
coverage are more likely to go without immunizations, end up in
emergency rooms when simple conditions turn complicated due to
a lack of primary care, and miss school because of untreated
illnesses.
• The first-ever state-by-state health system "scorecard" on
children's health care released by the Commonwealth Fund in May,
2008 ranked Maine third in the nation in overall performance. The
Fund for a Healthy Maine’s investment in children’s health care has
helped Maine to be a leader in this area.

35. FHM Programs: MaineCare
―The MaineCare program allows families like
mine to meet the health care needs of our
children, thereby assuring not only healthier
children, but a better quality of life for all of us.
Just the cost of my two children’s annual well
child visits and their biannual visits to the dentist
would be unaffordable on my salary. Taking
care of illnesses before they become so serious
as to need hospitalization or a trip to the
Emergency Room benefits my children, myself,
my employer and the whole health care system.
Because of the MaineCare program, families like
mine do not need to suffer the fear and anxiety
caused from living without health care coverage
for our children.‖
-Jami Collins
MaineCare recipient, Steep Falls

36. FHM Programs: Drugs for the Elderly
• The Drugs for the Elderly and Disabled (DEL) program helps low-
income elderly and people with disabilities to access the
prescription drugs that they need.
• Many elderly and people with disabilities in Maine struggle on fixed
incomes to make ends meet and would be unable to pay for their
prescription drugs without the help of the DEL program.
• As of January 2011, the DEL program is:
• Assisting 41,076 low-income elderly and people with disabilities with their
Medicare Part D expenses to ensure that they are able to access needed
prescription drugs.
• Helping more than 4,000 low-income elderly and people with disabilities who
are not receiving coverage through Medicare Part D to purchase needed
prescription drugs.

37. FHM Programs: Drugs for the Elderly
―I worked all my life as a tire
salesman until my diabetes forced me
to retire. I live on the limited income
I receive from my Social Security
check. My medical condition is
extremely fragile. I have serious
problems with my kidneys as well as
my right foot and my legs due to bad
circulation. When I had to switch
over to Medicare Part D program, I
was nervous that I would lose access
to needed prescription drugs. The
Drugs for the Elderly program has
guaranteed that I can continue to get
the life saving prescriptions that I
take for my heart, cholesterol,
diabetes and high blood pressure.‖
-Paul Boutin,
DEL recipient, Augusta

38. Protecting the FHM: Today’s Challenges
• The FHM saw trouble from day one:
• Abolishment of the trust fund
• Large chunks of the Fund diverted before receipt
• Diversions and program supplantation
• Attempts to protect the Fund for a Healthy Maine have met
with overall popularity, but ultimately failed:
• Constitutional amendment
• Cascading funds
• Separate votes
• With the advent of term limits, there are fewer legislators
who were present when the original plan was established.
More recently elected officials may not understand that this is
special funding and not simply General Fund or another Rainy
Day Fund.

39. Why Protecting the FHM is Important
• Every $1 taken from FHM prevention programs will add at least
$7.50 to Maine’s future health costs. Savings estimates go higher, but
one thing is clear: the FHM is an investment in our future health and
financial well-being. Every $1 taken from the FHM today will be $1 that is
not available to fund prevention programs for our most at-risk citizens
that improve oral health, reduce substance abuse, enhance physical activity
opportunities, provide child care and home visits to new parents, support
family planning, and prevent tobacco use among Maine children. Every
one of these efforts will significantly reduce Maine’s health care costs.
• The FHM is a nationally recognized success story. Maine’s use of
tobacco settlement dollars and specifically Maine’s tobacco prevention and
treatment program continue to draw both national and international
recognition for their comprehensive approaches to preventing costly
health care.

40. Why Protecting the FHM is Important (cont.)
• Maine has made tremendous progress in reducing tobacco use,
but significant challenges remain. 18.1% of Maine youth smoke,
health costs from tobacco use still total over $600 million per year, and
2,200 people still die every year from smoking.
• Tobacco companies are anxious for Maine to ease up. Despite
being a small state, Maine has made life difficult for the tobacco companies
and their allies. They want Maine to make the same mistakes as
Massachusetts and Florida, where youth smoking rates skyrocketed when
tobacco programs were reduced.
• Tobacco companies oppose cigarette price increases and want
you to believe that “we’re all done” when it comes to keeping
kids from smoking. Yet they are far from done in promoting their
deadly products - spending $59 million every year in Maine to find the
―replacement smokers‖ their internal documents describe.

41. Why Protecting the FHM is Important (cont.)
Protecting the Fund for a Healthy Maine is
Maine’s best hope for getting health care
costs under control. Support of the Fund for a
Healthy Maine means supporting reduction in health
care costs, preventing chronic disease and helping
Maine people get healthy!

42. Friends for the Fund for a Healthy Maine
The following organizations strongly endorse efforts that will keep tobacco
settlement money used as it was intended and prevent further diversions away
from the Fund for a Healthy Maine.
ACCESS Health Greater Waterville's Comm. for Children ME/National Assoc. of Social Workers Penobscot Community Health Center
Advocates for Children Harrington Family Health Center Maine Child Care Directors Association Penobscot Dental Access Coalition
Alliance for Children's Care, Education and Regional Medical Center at Lubec Maine Children’s Alliance Penquis
Supporting Services Healthy Acadia Maine Children’s Trust Penquis CAP
American Cancer Society, NE Division Healthy Androscoggin Maine Co-Occurring Policy Exchange People’s Regional Opportunity Program
American Heart Association Healthy Aroostook Maine Council of Senior Citizens Phoenix Academy of Maine
American Lung Association in Maine Healthy Casco Bay Maine Dental Access Coalition Piscataquis Public Health Council
American Nurses Association of Maine Healthy Communities of the Capital Area Maine Education Association Planned Parenthood of Northern NE
Androscoggin Cardiology Associates Healthy Community Coalition Maine Equal Justice Power of Prevention
Androscoggin Head Start & Child Care Healthy Lakes Region Maine General Health Project Integrate
Anthem Blue Cross Blue Shield Healthy Lincoln County Maine Head Start Director’s Association River Coalition
Aroostook Council for Healthy Families Healthy Oxford Hills Maine Hospital Association River Valley Healthy Communities Coalition
Aroostook County Action Program Healthy Peninsula Maine Medical Association Roman Catholic Diocese of Maine
Aroostook Mental Health Services Healthy Portland Maine Nurse Practitioners Association Sebasticook Valley Healthy Communities
Bangor Region Public Health and Wellness Healthy Rivers Region Maine Osteopathic Association Serenity House
Breathe Easy Coalition of Maine Healthy Waldo County Maine Peoples’ Alliance Southern Kennebec Healthy Communities
Bridgton Community Center Horace Mitchell Primary School Maine Primary Care Association Southern Kennebec Child Development
Bucksport Bay Healthy Communities Islands Community Medical Services, Inc. Maine Public Health Association Corp.
Coalition Katahdin Area Partnership Maine School Health Education Coalition St. Croix Valley Healthy Communities
Care Link/MRDC, Inc. Katahdin Valley Health Center Maine Society for Respiratory Care Start ME Right
Caribou City Council Kennebec Behavioral Health Maine State Chamber of Commerce Teen and Young Parent Program of Knox
Child & Family Opportunities, Inc. Kennebec Valley Community Action Maine State Nurses Association Co.
Child Care Services of York County Program Maine Substance Abuse Foundation The Community School
Children’s Dental Clinic Kennebunkport Public Health Department Maine Winter Sports Center Town of Lincolnville
Choose To Be Healthy Kittery Children’s Leadership Council Maine Women’s Lobby Town of Van Buren Recreation Department
City of Portland Kittery School Department MaineHealth Tri-County Mental Health Services
Coastal Enterprises, Inc. Kno-Wal-Lin Homecare and Hospice ME Assoc. of Child Abuse and Neglect Union River Healthy Communities
Coastal Healthy Communities Coalition Knox County Community Health Coalition Council United Way of Mid-Maine
Common Cause Maine Legal Services for the Elderly ME Assoc. of Health, Phys.Ed., Rec. & University of Maine
Community Concepts, Inc. Lewiston Public Schools Dance Vital Pathways
Consumers for Affordable Health Care Maine AFL-CIO Medical Care Development Waldo County Dental Task Force
Day One Maine Alliance for Addiction Recovery Midcoast Maine Community Action Waldo County Head Start
Downeast Health Services, Inc. Maine Alliance to Prevent Substance Abuse Mid-Maine Chamber of Commerce Wellspring, Inc.
Downeast Healthy Tomorrows ME Assoc. of Interdependent Milestone Foundation Winter Kids
Family Planning Association of Maine Neighborhoods MDI’s Behavioral Health Center York County Community Action Corp.
First Congregational Church Maine Association of School Nurses My Attitude Saves Kids York Hospital
Greater Portland Chambers of Commerce Maine Association of Substance Abuse Northern Maine Medical Center Youth Promise