Health coalitions face tough choices

LEWISTON — Community health advocates in Androscoggin County and across Maine were scrambling late last week to make sense of recently announced funding changes for the state's 27 Healthy Maine Partnership organizations.

Jose Leiva/Sun Journal

Ruth Cyr, left, of the Maine Cooperative Extension conducts a class with Shanna Rogers of Healthy Androscoggin on lead safety and nutrition at the St. Mary's Nutrition Center in Lewiston on Wednesday. Healthy Androscoggin is facing a 64 percent funding cut under a new state formula for the state's Healthy Maine Partnerships.

The changes, which include steep cuts in the amount of state funding some partnerships receive and sharp increases for others, are the result of a recently enacted state budget that closed an $83 million Department of Health and Human Services budget gap.  

The budget cut about $2.7 million from the Fund for a Healthy Maine, which funds the Healthy Maine Partnership organizations.

For Healthy Androscoggin, which will see its annual state funding reduced from $313,000 to $120,000 — a 64 percent decrease — the change likely will mean at least two popular programs will end, Executive Director Steven Johndro said.

Quit and Win, a smoking cessation program, and Get Fit and Win, a fitness promotion program, both widely embraced by local employers, could go by the wayside, Johndro said.

"We are really trying to figure out how this is going to completely impact our work and, at this point, we still don't know," Johndro said.

He said the funding reduction would mean the elimination of three full-time jobs and a reduction in hours for the organization's remaining staff.

Besides programs aimed at improving the overall health of the county's population with smoking cessation and fitness programs, Healthy Androscoggin provides educational programming on nutrition, lead poisoning in children and a host of other services.

Local lawmakers, including Sen. Margaret Craven, D-Lewiston, said the overall cuts to the program, coupled with the new way the remaining state revenue will be distributed, was mainly a political decision.

She and others are challenging the way state bureaucrats decided to divvy up the state funds and the process for selecting which partnerships would become funding winners and which would lose money.

Craven, who serves on the board of directors for Healthy Androscoggin, said she has requested an emergency meeting with Maine Department of Health and Human Services Commissioner Mary Mayhew and Maine Centers for Disease Control and Prevention Director Sheila Pinette.

"It doesn't make any sense," Craven said. "It's the way the money is being distributed that is so destructive."

For example, while Healthy Androscoggin will lose 64 percent of its state funding, Rumford-based Healthy River Valley's state funding is expected to go from $152,000 to $281,000.

Craven said dismantling an organization like Healthy Androscoggin, which serves more people, while boosting one like Healthy River Valley, which serves fewer people, was "baffling" to her.

She wants to see exactly how the partnerships were scored or ranked and what criteria Healthy Androscoggin was lacking. 

"We have nine employees here and we are going to have to lay some of them off because the money is going up to Rumford," she said. "It just doesn't make any sense."

Cutting programs, saving money

Christine Zukas, deputy director for the Maine CDC, said the changes were an attempt to reduce duplicate administrative costs, saving the state money while creating a more efficient way to deliver the most-needed preventive health services to communities around Maine.

Instead of fully funding each of the 27 partnerships, the state has designated healthy partnership lead organizations in eight geographic regions and one tribal region. The division is in line with the way the Maine CDC divides the state for other administrative and research purposes.

In western Maine, Healthy River Valley was selected to be the lead partnership, responsible for working with Healthy Androscoggin, Healthy Oxford Hills and the Healthy Community Coalition in Franklin County.

The lead partnerships were selected based on each partnership's demonstrated ability to meet previous contract expectations, efficient use of public resources, collaborative partnerships with the Maine CDC and ongoing support and promotion of new and developing public health infrastructure.

Zukas said Maine CDC employees who had experience working with the various partnerships around the state also made recommendations on which partnerships should be named lead.

She said the choices were not easy, and that population was not a factor in the selection process.

"That was put aside because we were really looking at which was the best (Healthy Maine Partnership) to be the lead, in terms of how they function and not in terms of the area they were serving," she said.

Zukas said that criterion may not have even been available. 

"There's no performance measure for how many people they reached in terms of their reporting, so that's not something you could even measure," she said. "In public health we are talking long term, so that's not really a measure you look at in the short term."

The change means the Maine CDC will only have to contract with nine agencies instead of 27, greatly reducing administrative costs, Zukas said.

As a lead agency, Healthy River Valley will receive $281,000 in the coming fiscal year. That's an 84 percent increase in annual state funding for the organization. 

That shift in funding left Johndro and others scratching their heads; the population served by Healthy River Valley, an estimated 28,000 people, is only about a quarter of the 108,000 people estimated to be served by Healthy Androscoggin.

Under the new system, Healthy Androscoggin will lose three full-time staff positions and reduce hours for the remaining staff. One of those positions includes a full-time grant writer, who works to secure other sources, including private grants and federal money for the organization, Craven said.

Patricia Duguay, executive director of Healthy River Valley, said her agency also was surprised, and still trying to grasp what the shift in funding and responsibility would mean. All nine of the lead partnerships are expected to meet with DHHS and Maine CDC officials later this week when more details will be hashed out.

Even with the additional funding for her agency, Duguay said the challenges of making it work for the entire region, and filling the gaps left in the public health system by the overall cut, will be immense.

The elimination of health coordinators in 27 public schools in Maine was part of the new void in services the partnerships would attempt to fill, Duguay said.

What the contracts between the Maine CDC and the lead partnerships will contain was still unknown. Also unknown was how the contracts between the lead partnership and the other supporting partnerships would be worked out, Duguay said.

"I'm kind of in a holding pattern at this point," she said.

Process not transparent

Zukas said the reform includes a reduction in the number of focus areas each partnership could apply to work on. Previously, the organizations could pick from among about 70 health objectives. The new formula will see contracts focusing mainly on tobacco use, physical activity and nutrition.

"Because the amount of money has been reduced, the objectives have been reduced," Zukas said. 

"The lead HMP will not be instructing the supporting HMPs, but they will need to work with the supporting HMPs to make sure the objectives that are chosen reflect the needs of the community they serve," she said.

She said the focus would be on physical activity.

For Johndro, who heads one of the oldest partnerships in the state and one that has been heralded at the national level, the selection process was anything but transparent.

He said he had never been made aware of any negative issues Healthy Androscoggin had in the criteria used to select lead agencies.

"We have not seen any kind of scoring grid or anything like that, and I would like to know the process and who was involved in that," Johndro said. He said if Healthy Androscoggin had not satisfied the state in the past, it would not have been awarded funding.

"For us, it isn't about questioning River Valley's ability to be the lead partnership," Johndro said. "We just really would like to know and understand how these decisions were made."

Craven said the process was part of a trend in Gov. Paul LePage's administration to make public policy via a bureaucratic, rule-making process, often in private meetings and not in a public, legislative one.

"And, after all, we are talking about the public's money here," Craven said.

Zukas acknowledged that Maine CDC and DHHS had a short time frame for figuring out how to fund the partnerships with the new funding levels because the final DHHS budget was passed so late in the legislative session.

"The timing was such that it was really impossible," she said. "We didn't know what the cut would be until they made their decision. So, it meant doing that work to determine the plan of action, vetting it with the commissioner, having the commissioner give the OK, and the day after the commissioner gave the OK ... it was announced to the statewide coordinating committee and the HMPs and school health coordinators."

Now, with less than a week before new contracts must be in place in order to be funded for the new fiscal year, starting July 1, partnership leaders are worried the contracts will not be written or put in place in time.

Zukas said the intent was that all contracts between the state and the lead partnerships would be in place in time. 

"The existing contracts expire June 30," she said. "We are working to have them in place July 1st, but there's a lot that goes into that. But that's our hope."

She was unsure whether the contracts between the lead partnerships and the supporting ones could be in place by July 1, although that was also the state's intent. 

"We are under discussions with our contracting folks to determine how that best can work — but I can't tell you how that's going to be right now," Zukas said.

sthistle@sunjournal.com

Editor's note: In December 2013, the Office of Program Evaluation and Government Accountability issued a report concluding a host of problems with the Healthy Maine Partnership funding process, including the destruction and creation of records in response to a Sun Journal Freedom of Access Act request. According to the OPEGA investigation, "there were multiple problems with the process that undermined the integrity and credibility of the results and created an opportunity for Maine CDC to manipulate the final outcomes in the lead selection." That report is available at www.maine.gov/legis/opega/reports

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Comments

Steve  Dosh's picture

Health coalitions face tough choices

Scott Sunday night here in Hawai'i
Nice analysis ? CMMC and St. Mary's ? C o n s o l i d a t e
" Craven said the process was part of a trend in Gov. Paul LePage's administration to make public policy via a bureaucratic, rule-making process, often in private meetings and not in a public, legislative one," i.e., secrecy , by fiat and executive orders . Don't forget that medical practices have gotten much better this century and even become more decentrailised they'ya in ME and closer to the patient patients
You voted him in , Republicans ?  You stand where you sit • Taxes pay for 9.11 EMS , Police and Fire services , too , plowing roads, fixing bridges , trash , National Guard , Marines , Navy , Air Force, Navy , Coast Guard , Army, etc . .
h t h ? Dr. Dosh http://www.pnhp.org/ows/index.php We like Obamacare •  He's Irish , right ? :)

FRANK EARLEY's picture

Bottom line....

The area with the larger population gets more than half their funding cut, while a much smaller population has their funding doubled.
That must be the new LePage math, no one else could be that stupid......

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