Maine has a long history of effectively addressing public health issues and improving health outcomes within the MCH population. Over the last twenty years, Maine reduced tobacco use rates among the adult and adolescent population, reduced births among adolescents and reduced premature births. Maine achieved these improvements in health status through collaborative work with other organizations in the public, private and non-profit sectors.
Maine’s public health system has some unique strengths that lend themselves to a healthy population. Maine is divided into nine public health districts that bridge the gap between local and state public health infrastructure; this work continues with the integration of prevention, inclusive of MCH services. There are eight county-based public health districts and one tribal health district with planning considerations given to unique geographic and population needs.
The Maine Center for Disease Control and Prevention (Maine CDC) MCH epidemiology team conducts data analysis and provides technical assistance to programs and partners in the use of data to select and implement evidence-based strategies that address poor health outcomes. The team is composed of experienced epidemiologists who have a thorough understanding of maternal and child health in Maine.
Maine’s Maternal, Fetal and Infant Mortality Review Panel Coordinator performs abstraction and works with the MCH epidemiologist to determine cases to review during panel meetings. While the Panel is still growing, the progress made has allowed the experts the opportunity to recommend system-level changes to improve the health of Maine people.
Another strength of Maine’s public health system are the partnerships developed over time. Maine is a very small state when it comes to health care and social service providers. This is an advantage as it presents opportunities for voices from a variety of providers and consumers. The addition of virtual participation, where available, has allowed for direct and instant connections.
Despite our many strengths there remain challenges to improving the health of Maine people. For example, there are significant gaps in health-related services, especially in Maine’s more rural counties. These services include labor and delivery units, behavioral health providers and other medical providers. Currently, only 26 of Maine’s 33 hospitals provide labor and delivery services. Many rural areas in Maine are underserved for primary care, dental care, mental health providers, and substance use providers. The lack of providers in rural areas translates to families having to drive long distances to receive services.
In addition to driving long distances for services, Maine’s Internet connection is weak or non-existent in some areas limiting the number of telehealth opportunities in areas where need is the greatest. Governor Mills announced legislation in April 2021 (LD 1484) establishing the “Maine Connectivity Authority” to expand broadband using American Rescue Act Plan funding. This expansion holds promise for connecting families to services.
Maine CDC Role in Delivery of Title V Services
The Maine CDC, an Office of the Maine Department of Health and Human Services (Maine DHHS), is responsible for providing essential public health services that preserve, promote and protect the health of the State’s population. The State Health Improvement Plan, designed to improve the health of all Maine people, identified public health priorities and outlined objectives, strategies and outcomes for statewide action. The Maine CDC’s role is not only to deliver MCH-related services, but to also act as a connector between State offices, providers and consumers.
Maine’s systems of care for meeting the needs of underserved and vulnerable populations span multiple DHHS offices including Maine CDC and the Office of MaineCare Services (OMS). Maine CDC houses programs serving these populations that include WIC and Children with Special Health Needs (CSHN). Both MaineCare and WIC serve clients who meet Medicaid income guidelines, as well as other eligibility criteria. These programs provide medical and dental insurance to vulnerable families as well as food security. They play an important role in a pregnant woman’s prenatal care by ensuring proper nutrition to help the baby grow and ensuring they seek medical care when necessary. The WIC program provides breast pumps for nursing mothers, as well as formula for babies when needed. It also provides baby food and other nutritional foods for families. MaineCare provides medical coverage for children up to age 19. The CSHN Program works to ensure that families receive care coordination when a child does not pass a hearing screen, is diagnosed with a cleft lip and/or palate, or diagnosed with a genetic condition. The CSHN Program connects families to specialty providers and clinics.
The Maine CDC partnered with MaineCare on The Medicaid Innovation Accelerator Program for the Maternal and Infant Health Initiative. Although this project has ended, Maine CDC and MaineCare continue to find opportunities to build relationships. MaineCare representatives continue to participate in the MCH Domain Lead and Partner Team that meets monthly to coordinate MCH efforts across programs responsible for implementing the MCH Block Grant work plan. In addition, Maine CDC continues to collaborate with MaineCare on the Centers for Medicare and Medicaid Maternal Opioid Misuse (MOM) Model Grant implementation.
In 2017, Maine began using the CradleME referral system coordinated by Maine CDC Public Health Nursing. All Maine birthing hospitals, prenatal care providers, families and others are encouraged to submit a referral so families can obtain needed services from Public Health Nursing or Maine Families Home Visiting at no cost. In 2021, Maine CDC expanded the CradleME referral system to include WIC and Maine MOM participants.
Pediatric Care Capacity
Maine has one children’s hospital, The Barbara Bush Children's Hospital at Maine Medical Center located in the city of Portland. It has 116 beds, including 31 Level III NICU Beds, 20 Level II Continuing Care Nursery beds and 8 PICU beds.44
The American Board of Pediatrics tracks the number of diplomates (i.e., pediatricians who have passed the General Pediatrics Certifying Examination) currently in the pediatric workforce. As of July 2018, there were 231 general pediatricians age 70 or less in Maine, which represented a ratio of one general pediatrician per 1,084 children, compared to 1:1261 nationally. The ratio of pediatric specialists age 70 or less was 1:816 compared to 1:943 nationally.45
The Maine DHHS has placed an emphasis on integrating physical, social and behavioral health services to ensure greater access to services as well as ensure the services are effectively coordinated. For example, Title V contracts with the two largest hospital systems to provide clinics for children who have a cleft lip and/ or palate. The clinics are responsible for providing integrated case management through a Cleft Team who provide optimal evaluations of newborns with craniofacial anomalies, and subsequent evaluations and recommendations through age 21. The Cleft Team monitors short and long-term outcomes and develops and implements treatment plans for individual patients. The goal of the Cleft Lip and/ or Palate clinics is to ensure that patient care is provided in a coordinated, consistent manner with proper sequencing of evaluations and treatment within the framework of the patient’s overall developmental, medical, and psychological needs as recommended by the American Cleft Palate-Craniofacial Association Parameters of Evaluation and Treatment.
In 2017, Maine voters approved Medicaid expansion in a referendum vote, and in January of 2019 Governor Janet Mills approved the plan to fund the expansion. As of May 1, 2021, 77,838 people were enrolled through the MaineCare expansion, including 66,204 adults without children, as well as 11,634 parents and caretaker relatives.[1]
Geography
Maine is the northernmost and largest state in New England and the easternmost state in the United States. Maine's population is growing at a slower rate than most of the U.S. and aging at a faster rate. The majority of residents reside in rural towns and small cities. The demographic and geographic factors that contribute to Maine's uniqueness among the New England states are the very same factors that create complex challenges for Maine's Title V agency as we strive to improve the health outcomes of the MCH population.
In 2020 there were 1.35 million people residing in the state of Maine.[2] Between 2010 and 2020 Maine's overall population increased 1.7% compared to 6.5% nationally.2 During this period there were more deaths than births (-14,657 people), however domestic migration (+22,584) and international migration (+15,351) resulted in modest population growth and increased racial and ethnic diversity in the state.[3] In contrast, net natural increases caused 63% of the U.S. population increase in this period.3
Maine has three metropolitan (metro) areas; Portland-South Portland (pop. 538,500), Lewiston-Auburn (pop. 108,277) and Bangor (pop. 152,148).[4] Collectively, 59.4% of Maine's population resides in these three metro areas4 (compared to 79.0% of U.S. residents who live in metro areas).[5] More than one third (37.4%) of Maine's population lives in the two southernmost counties (Cumberland and York)4 that account for only 6% of the state's land area.[6]
The average population density of Maine is 43.1 people per square mile compared to 87.4 people per square mile in the United States.6 However, the population density of Maine varies dramatically across the state, from 337 people per square mile in Cumberland County where Maine's largest city (Portland) is located, to four people per square mile in Piscataquis County.6
The median age of Maine's population (45.1 years) is more than six years older than the U.S. (38.5 years) and is the highest in the country.[7] Maine’s State Economist projects that by 2036 a greater percentage of Maine's population will be age 65 years and older compared to 19 years and younger (28.4% vs 18.1%). That represents a 33% increase for the population 65 years and older and a 21% decrease for the population under the age of 19 between 2019 and 2036.[8] Maine is expected to experience an overall population decline of 0.5% between 2019 and 2036. Only three of Maine’s 16 counties (York, Cumberland and Androscoggin) are projected to have positive population growth in that time.8
Maine's MCH populations (i.e., children, including those with special health needs and women of reproductive age) represent a significant proportion of the population. In 2019, children under 18 years of age plus women ages 18-44 represented 34.1% of Maine's population.4 Children under 18 years of age comprised 18.3% of the state's population. Nationally, children under age 18 comprised 22.2% of the population.4
In 2019, the median age of women in Maine was 46.5 years.[9] Women aged 18-44 years comprised 15.7% of Maine's population, compared to 17.8% nationally.4
Prevalence estimates of current disability or special health needs among Maine children differ depending on the definition used. According to the 2018-19 National Survey of Children’s Health there are nearly 57,384 children with special health care needs in Maine, representing 23.0% of children under age 18 years.[10]
Demographics
Family
According to estimates from the 2015-2019 American Community Survey (ACS) the average household size in Maine is 2.3 people and the average family size is 2.8.[11] A quarter of households (25.3%) in Maine include one or more children under age 18, compared to 31.0% nationwide.11 Of the householders living with their own child under age 18, 16.2% are female-headed (no husband present) households and 5.7% are male-headed (no wife present) households. Over a third of Maine grandparents (34.1%) report being responsible for their grandchildren.11 Of Maine women aged 15 years and over, 52.1% are currently married, 31.3% have never been married, 12.8% are divorced, 3.0% are widowed and 0.9% are separated. About a third (31.3%) of births in Maine are to unmarried women, similar to 33.7% nationwide.11
Racial and Ethnic Diversity
According to the 2015-2019 ACS, Maine's population is (race alone, not in combination): 94.3% White, 0.6% American Indian or Alaska Native, 1.4% Black or African American, 1.1% Asian, and 2.2% are two or more races. People of Hispanic origin comprise 1.7% of the population.[12] Of Maine's children under age 18 (race alone, not in combination), 90.0% are White, 2.5% are Black or African American, 0.9% are American Indian or Alaska Native, 1.2% are Asian, 4.9% are two or more races and 2.8% are Hispanic.[13] The state is gradually becoming more racially diverse, though at a slower rate than the country as a whole. In nearly ten years, the proportion of the population that is White alone decreased only about 1% (from 95.6% in 201012 to 94.4% as of 2019).[14]
Based on 2015-2019 ACS data 22,920 Mainers identify as American Indian alone or in combination with one or more other races.12 There are four federally recognized Indian tribes and five tribal communities in Maine today: Aroostook Band of Micmac Indians, Houlton Band of Maliseet Indians, Passamaquoddy Tribe of Indian Township, Passamaquoddy Tribe at Pleasant Point, and Penobscot Indian Nation.[15] The majority of Maine's Native American population resides in or near the five small, rural communities of Indian Island (Penobscot Nation), Pleasant Point (Passamaquoddy tribe), Indian Township (Passamaquoddy tribe), Houlton (Houlton Band of Maliseet) and Presque Isle (Aroostook Band of Micmac Indians).15
A total of 3,369 Passamaquoddy tribal members are listed on the tribal census rolls, with 1,364 on the Indian Township census and 2,005 listed on Pleasant Point census.[16] The Aroostook Band of Micmac Indians is estimated at 1,489+ members.[17] The Houlton Band of Maliseet Indians is comprised of approximately 1,700 members.[18] An estimated 2,398 members comprise the Penobscot Nation population.[19]
In 2015-2019, 3.6% of Maine residents were foreign-born; the proportion within Maine's counties ranged from 1.5% in Franklin and Oxford Counties to 6.1% in Cumberland County.11 Of Maine's foreign-born population 28.7% were born in Asia, 23.8% in Europe, 20.2% in North America, 15.9% in Africa and 10.4% in Latin America.11 Among Maine's foreign born, 74.9% entered the U.S. before 2010. Slightly more than half (56.5%) of Maine's foreign-born are naturalized U.S. citizens. Across Maine, 6.1% of the population aged five and older spoke a language other than English at home; approximately 1.5% spoke English less than "very well."11
Emerging populations in Maine include people of Somalia, Sudan, Angola, Congo, Ethiopia, Iran and Iraq who are arriving in Maine as primary refugees or secondary migrants.[20] Refugees are individuals granted refugee status overseas by the U.S. Department of Homeland Security, are brought to the U.S. for resettlement by the U.S. Department of State, and are assisted with resettlement in U.S. communities through the Office of Refugee Resettlement and voluntary agencies.[21] In FY 2018, 147 refugee arrivals were initially resettled in Maine (21 from the Congo, 20 from Burundi, 17 from Rawanda, 4 from Sudan, 3 from Iraq). The total number of refugees in Maine has fallen since 2013 when 448 refugees were resettled.20
Secondary migration is a legal term that refers specifically to refugees placed for resettlement initially in one location in the United States and decide to relocate to another part of the United States. Although immigration data do not track secondary migration, it is the largest force affecting immigration into Maine. An estimated 75% of new Mainers are secondary migrants.20 In FY18 Catholic Charities Refugee and Immigration Services resettled approximately 66 primary refugees assisted 40 secondary migrants and 41 asylees.19
In 2019, around 800 asylum seekers, primarily African, arrived in Portland, Maine to await decisions on their status. City and state government, as well as local non-profit and for-profits organized a massive effort to feed, clothe, house, and provide legal assistance to asylees using private and public resources. Over $900,000 in federal funding and $900,000 in private donations were obtained to help settle the asylees in Portland and surrounding communities.[22]
Educational Attainment
In 2015-2019, 92.6% of Maine residents age 25 and over were high school graduates, compared to 88.0% nationally.11 The county-specific proportion of high school graduates age 25 and older ranges from 88.6% in Aroostook County to 95.1% in Cumberland County.11 Although a slightly higher percentage of Maine residents over age 25 years completed high school compared to the U.S., a slightly lower percentage have a bachelor’s degree or higher (31.8% Maine vs 32.1% U.S.). Among adults age 25+ 12.4% have completed an advanced degree.11 Among Maine women, 95.7% of those age 25-34 years and 96.6% of Maine women age 35-44 years were high school graduates; both proportions were higher than those among women of these age groups in the United States (92.2% and 89.9%, respectively).[23]
Socioeconomic Indicators
Income and Poverty
A "livable wage" is the amount Maine families need to earn to make ends meet considering actual living expenses including housing, health care, child care, transportation, taxes, and necessities (clothing, personal care items, etc.). According to the Living Wage Calculator designed by the Massachusetts Institute of Technology, the annual household income required in 2020 for a two-parent (2-earner), two-child Maine family to meet their basic needs was $87,929 (a wage of $21.14/hour per adult).[24] The county-specific livable wage for this family type ranged from $81,693 ($19.64/hour per adult) in Piscataquis County to $98,076 ($23.58/hour per adult) in Cumberland County. For single-parent Maine families with two children, the average annual income required is $79,733 ($38.33/hour) with county-specific estimates ranging from $73,496 ($35.33/hour) in Piscataquis County to $89,879 ($43.21/hour) in Cumberland County.24 The livable wage is considerably higher than both the federal poverty level (FPL) and the income of a minimum wage earner. As of March 2021, Maine's $12.15 per hour minimum wage is $4.90 cents higher than the federal standard of $7.25.[25] In Maine, a full time year-round minimum wage worker will earn $486 per week or $25,272 per year. In 2021, the FPL for a family unit consisting of two people is $17,420 per year. The FPL for a family of four is $26,500.[26] While significant portions of the MCH population fall under the FPL, even higher proportions live in families that do not earn livable wages.
Although states in the Northeast tend to have median household incomes above the U.S. median, Maine's median household income is $4,925 less than the U.S. median ($57,918 vs. $62,843).[27] There is considerable variation in income across Maine counties. In 2015-2019 the median household income ranged from $40,890 in Piscataquis County to $73,072 in Cumberland County.27
According to the 2015-2019 ACS, 15.9% of Maine people are at or below 125% FPL, 11.8% are at 100% FPL and 4.5% are at or below the 50% FPL.[28] Poverty is inversely related to educational attainment; 26.2% of those with less than a high school diploma are below the FPL compared to 13.8% of high school graduates, 9.1% of those with some college, and 4.1% of those with a bachelor's degree or higher.28
The poverty rate among Maine children under age 18 is 15.1%.28 The county-specific proportions of children under age 18 below the FPL ranged from 7.4% in York County to 20.4% in Somerset County.28 Among female-headed households with children under 18 years of age, 25.6% lived in poverty (vs 28.6% U.S.) in 2015-2019.28 Among families with children under age five, 13.0% lived below poverty, and nearly half (42.5%) of female-headed households with children under five lived in poverty in 2015-2019; this is similar to households in the U.S. (40.5%).[29]
Labor Force and Employment
Maine's civilian labor force was estimated at 676,547 in 2020.[30] The proportion of adults age 16 and over in the labor force ranges from 47.5% in Piscataquis County to 69.1% in Cumberland County.27 The proportion of children under age 6 with all parents in the labor force is 70.7% in Maine, and ranges from 51.8% in Piscataquis County to 77.5% in Androscoggin County.27 Among women ages 16 years or older, 59.5% are in the civilian labor force.27 Median earnings for women working full time, year-round in 2015-2019 were 81.1% of men’s earnings ($41,228 vs. $50,823).27
The 2020 seasonally adjusted unemployment rate for Maine was 5.4%, up 2.7% from the same period last year.30 Unemployment figures do not reflect the number of underemployed and those who became discouraged and stopped looking for work. The increase in the unemployment rate in 2020 is likely due in large part to COVID-19 and its impact on Maine’s service industry. Based on U.S. Census data, Maine has a larger proportion of its jobs in education, health care, and retail trade sectors than in the U.S. overall, while a smaller proportion of its jobs are in manufacturing, wholesale trade, and administrative services sectors.27
Income Assistance
In 2019 approximately 22.9% of children under the age of 18 lived in households that received Supplemental Security Income, cash public assistance income, or Supplemental Nutrition Assistance Program (SNAP) in the previous 12 months;[31] this proportion varied by family type. Among children living in married couple family households, 14.1% had household income from one or more of these sources. Among children living in households with a female householder (no husband present) 42.0% received assistance, and among children living in households with a male householder (no wife present), 38.7% received assistance from one or more of these sources.31 SNAP assistance is one of the most wide-spread low-income benefit programs in Maine. According to 2019 data, approximately 12.3% of Maine's households were receiving supplemental nutrition assistance.[32] The median household income of SNAP recipients in 2019 was $19,327.32 The monthly benefit per person in FY2018 averaged $108.[33] Maine’s WIC program served, on average, 16,523 participants each month during FY20. This included 3,383 women, 3,827 infants, and 9,313 children. Enrollment in WIC has been decreasing annually over the past five years. This is a consistent trend across states. It may be partially due to declining numbers of births. During the 2019-2020 school year, 43.9% of Maine schoolchildren were eligible for the free and reduced meals program.[34]
Housing
According to 2015-2019 ACS data, 75.4% of Maine's housing units are occupied.[35] Among Maine's 559,921 occupied housing units, 72.3% are owner-occupied and 27.7% are renter occupied.35 The median gross monthly rent is $853.00. Among renter-occupied units, 36.5% consume more than a third of renters’ household income.35 Among owner-occupied units, 61.7% have mortgages; and of those with mortgages, 20.1% have housing costs which consume more than a third of owners’ household income.35
Among Maine's occupied housing units, 7.1% have no vehicles available, 33.4% have one vehicle, and 59.5% have two or more vehicles available.35 1.7% of occupied housing units have no telephone service available. Of Maine's occupied housing units, 70.4% are detached single-unit structures and 8.3% are mobile homes. Nearly a quarter of housing units (24.1%) were built before 1940.35
Finding affordable housing is a challenge for some Maine residents. According to a 2018 Maine State Housing Authority (MSHA) Homeownership Affordability Index, the median price of homes increased 45% between 2015 and 2020 ($176,000 to $255,000). Maine's median income increased 25% during the same period.[36] Currently, the most affordable communities are in the more rural parts of the state (Aroostook, Piscataquis, and Somerset) with the least affordable in the southern and coastal areas.36 Statewide, about 55% of Maine households are unable to afford a median home price and 57% cannot afford the rent for an average two-bedroom apartment ($1,062).36
Homelessness
Nationally, about a third of the homeless population is less than age 24.[37] Compared to children with stable housing homeless children are more likely to have health problems, developmental delays, learning disabilities, emotional difficulties, and mental disorders.37
In January 22, 2019, (the most recent available data) the Maine State Housing Authority Point in Time Survey identified 1,215 homeless individuals in shelters, an 8% increase from 2018.[38] Of those surveyed, 259 had a mental illness, 107 were victims of domestic violence and 166 had a substance abuse problem. Twenty-three percent (279) of homeless people were under age 18, an increase of 2% from 2018.38 In FY 2019, the average number of nights spent in a shelter per person was 69, and the median was 40.[39]
According to the U.S. Department of Housing and Urban Development’s 2020 Annual Homeless Assessment Report, “Homeless describes a person who lacks a fixed, regular, and adequate nighttime residence.” That report estimated 2,097 individuals in Maine were homeless on a single night in January, virtually unchanged from 2019.[40] Of those, 808 were people in families with children, and 139 were unaccompanied homeless youth. According to that report, Maine has one of the lowest rates of unsheltered homeless people in the U.S (Maine: 6.7%; New York 5.0% (lowest) California 70.1% (highest).40
COVID-19’s Impact
The impact of the COVID-19 pandemic has had dramatic impacts on the lives of all Mainers. In March of 2020, much of the state began to severely limit gatherings and travel. Many businesses shuttered, and schools went virtual, putting many out of work, and burdening working parents with childcare responsibilities. As of June 2021 most restrictions were lifted.
Pandemic-related restrictions, fears, and logistical challenges have taken a toll on people’s health. Based on a survey of Maine adults conducted in March 2021, 8% of adults said that childcare or dependent care had prevented them from seeking healthcare; 30% of Mainers said that a fear of contracting the virus had prevented them from seeking healthcare; 31% said that they had worse diet habits during the pandemic and 45% said they had worse exercise habits during the pandemic.[41]
As of July 26, 2021, Maine’s cumulative case count was 69,904 cases, with a case rate of 522.3 per 100,000 people.[42] That is 20 times lower than the national case rate of 10,281 per 100,000.[43] Maine has had 897 deaths and 2,125 hospitalizations from COVID-19. While Maine overall has not had dramatic case rates of COVID-19, the impacts of the virus have hit some populations hard. While Black or African American Mainers make up less than 2 percent of the population, they represent 5% of the confirmed cases.42 The vast majority of deaths (55%) have been among those age 80+. Cumulative case rates have been much higher in southern counties, and lower in northern counties. They range from 256.5 per 100,000 in Hancock County, to 788.1 per 100,000 in Androscoggin County. Among Maine youth, there have been 20,456 cases of COVID-19.42 About 30% of COVID-19 cases in Maine have been among youth under age 25. Of these cases, 35% have been among those 20-24; 27% have been among 15-19 year olds; 16% among 10-14 year olds; 12% among 5-9 year olds and 9.5% among 0-4 year olds. The proportion of COVID-19 cases that are among youth under age 25 has increased significantly since COVID-19 was first diagnosed in Maine. In March 2020, about 7% of COVID-19 cases were among youth under age 25; this peaked in May 2021 when about 37% of all COVID-19 cases were among youth. As of July 13, 2021, 47 youth under age 25 had ever been hospitalized for COVID-19 in Maine.42
Vaccination roll-out prioritized older Mainers, and frontline health workers and educators. As of July 28, 2021, 68% of Maine’s population age 12 and over have been fully vaccinated .42 Among youth 12-19, about 52% have been fully vaccinated. There is variation in vaccination rates by county and by age. Maine’s lowest vaccination rates are among those aged 20-29 years (50% vaccinated). Our highest vaccination rates are among adults over age 70; among this age group 87% have been fully vaccinated. Maine’s more rural and northern counties have lower vaccination rates compared to coastal and southern counties. Vaccination rates across Maine counties range from 54% in Somerset County to 81% in Cumberland County. In a survey of a random sample of adults conducted by the National Association of Chronic Disease Directors in March 2021, 77% of Maine adults reported that they would agree to be vaccinated if it is offered to them.41 However, we have not yet reached this proportion and vaccination rates have slowed substantially in recent weeks.
Statutes relevant to the Title V Program
Numerous state statutes inform Maine’s Title V Program and provide guidance on the parameters of the programs within Title V. For example, the family planning services statute requires that schools provide comprehensive sexuality education that includes accurate and age appropriate education on sexual health. To assist in meeting this requirement the Maine CDC funds the Department of Education to work with local school districts in developing curriculum that meets the standards outlined in the statute. The Maine CDC’s Public Health Nursing program utilizes the Lead Poisoning Prevention statute to guide their work with the Lead Poisoning Prevention Program in responding to lead exposed or poisoned children and their families.
A listing of state statutes that have relevance to the Title V program is included in Section V Supporting Documents.
[1] Maine Department of Health and Human Services. MaineCare Expansion Update. May 1, 2021. Accessed 5/12/21 from: https://www.maine.gov/dhhs/expansion.shtml.
[2] US Census Bureau, Population Division. Annual Estimates of the Resident Population for the United States, Regions, States, the District of Columbia, and Puerto Rico: April 1, 2010 to July 1, 2020 (NST-EST2020). https://www2.census.gov/programs-surveys/popest/tables/2010-2020/state/totals/nst-est2020.xlsx
[3] U.S. Census Bureau. Table 4. Cumulative Estimates of the Components of Resident Population Change for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2019. 2019. Cited 3-5-20; Available from: https://www.census.gov/newsroom/press-kits/2019/national-state-estimates.html.
[4] U.S. Census Bureau. 2019 American Community Survey 1-Year Estimates. Table B01001: Sex by Age. Universe: Total population. Cited 3-22-21. Available from: https://data.census.gov/cedsci/table?q=.%20B01001&g=0100000US_0400000US23,23.050000_310M500US12620,30340,38860&tid=ACSDT1Y2019.B01001&hidePreview=true.
[5] U.S. Census Bureau. 2010 Census Summary File 1. P2: URBAN AND RURAL - Universe: Total population. Cited 4-4-19; available from: https://data.census.gov/cedsci/table?q=P2%3A%20URBAN%20AND%20RURAL%20&tid=DECENNIALAIAN2010.HCT1&hidePreview=false.
[6] Index Mundi. Maine Land area in square miles, 2010 by County. Cited 4-4-19; Available from: https://www.indexmundi.com/facts/united-states/quick-facts/maine/population-density#map.
[7] U.S. Census Bureau. 2019 American Community Survey 1-Year Estimates. ACS DEMOGRAPHIC AND HOUSING ESTIMATES. Table DP05. Cited 3-22-21; Available from: https://data.census.gov/cedsci/table?t=Age%20and%20Sex&g=0100000US_0400000US23&tid=ACSDP1Y2019.DP05&hidePreview=true.
[8] Maine State Economist. Maine State and County Population Projections. 2018. Cited 3/22/21; Available from: https://www.maine.gov/dafs/economist/demographic-projections.
[9] U.S. Census Bureau. 2019 American Community Survey 1-Year Estimates Age and Sex. Table S0101. Accessed 3-22-21 from: https://data.census.gov/cedsci/table?q=median%20age&g=0400000US23&tid=ACSST1Y2019.S0101&hidePreview=true.
[10] National Survey of Children’s Health, 2018-2019. Data Resource Center for Child and Adolescent Health. Cited 3-22-21; Available from: https://www.childhealthdata.org/browse/survey/results?q=6919&r=21
[11] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. DP02: Selected social characteristics in the United States. Cited 3-22-21 Available from: https://data.census.gov/cedsci/table?q=selected%20social%20characteristics&g=0100000US_0400000US23&tid=ACSDP1Y2019.DP02&hidePreview=true.
[12] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. ACS DEMOGRAPHIC AND HOUSING ESTIMATES. Table DP05. Cited 3-22-21; Available from: https://data.census.gov/cedsci/table?t=Age%20and%20Sex&g=0100000US_0400000US23&tid=ACSDP5Y2019.DP05&hidePreview=true.
[13] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. CHILDREN CHARACTERISTICS. Table S0901. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=S0901&g=0400000US23&tid=ACSST5Y2019.S0901&hidePreview=true.
[14] U.S. Census Bureau. Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for Maine: April 1, 2010 to July 1, 2019. 2019 Population Estimates. Cited 3-23-21; Available from: https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html.
[15] Maine Division of Public Health Systems. Tribal Public Health. Cited 3-23-21; Available from: http://www.maine.gov/dhhs/mecdc/public-health-systems/tribal/.
[16] Passamaquoddy Tribe at Indian Township. About the Passamaquoddy Tribe. 2010. Cited 3-9-20; Available from: https://www.passamaquoddy.com/?page_id=14.
[17] Aroostook Band of Micmacs. Official Website of Aroostook Band of Micmacs. 2018. Cited 3-23-21; Available from: http://www.micmac-nsn.gov/.
[18] Houlton Band of Maliseet Indians. Houlton Band of Maliseet Indians: About Us. 2010. Cited 3-23-21; Available from: http://www.maliseets.com/index.htm.
[19] Penobscot Indian Nation. Cited 3-23-21; Available from: http://www.penobscotculture.com/index.php/8-about/81-tribal-facts.
[20] Catholic Charities of Maine. FAQ’s: Who are the New Mainers? Cited 3/23/21; Available from: https://www.ccmaine.org/refugee-immigration-services/faqs.
[21] U.S. Department of Health and Human Services, Administration for Children and Families, and Office of Refugee Resettlement. Who We Serve. 2012. Cited 3-23-21; Available from: https://www.acf.hhs.gov/orr/resource/who-we-serve-refugees.
[22] Bangor Daily News. Portland urges immigration officials to fix border policies regarding asylum seekers. https://bangordailynews.com/2020/01/23/news/portland-urges-immigration-officials-to-fix-border-policies-regarding-asylum-seekers/.
[23] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. S1501: Educational Attainment. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=S1501&g=0100000US_0400000US23&tid=ACSST5Y2019.S1501&hidePreview=true.
[24] Massachusetts Institute of Technology. Livable Wage Calculator. 2021. Cited 3-23-21; Available from: http://livingwage.mit.edu/states/23/locations.
[25] U.S. Department of Labor. Minimum Wage Laws in the States – January, 2021. Cited 3-23-21; Available from: https://www.dol.gov/whd/minwage/america.htm.
[26] U.S. Department of Health and Human Services and Assistant Secretary for Planning and Evaluation. 2021 HHS Poverty Guidelines. Cited 3-23-21; Available from: https://aspe.hhs.gov/poverty-guidelines
[27] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. Table DP03. Selected Economic Characteristics. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=DP03&g=0100000US_0400000US23,23.050000&tid=ACSDP5Y2019.DP03&hidePreview=true.
[28] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. S1703: Selected Characteristics of People at Specified Levels of Poverty in the Past 12 Months. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=S1703&g=0100000US_0400000US23,23.050000&tid=ACSST5Y2019.S1703&hidePreview=true.
[29] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. S1702: Poverty Status in the Past 12 Months of Families. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=S1702&g=0100000US_0400000US23&tid=ACSST5Y2019.S1702&hidePreview=true.
[30] Maine Center for Workforce Research and Information. Unemployment and Labor Force. Cited 3-23-21; Available from: http://www.maine.gov/labor/cwri/laus.html.
[31] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. B09010: Receipt of Supplemental Security Income (SSI), Cash Public Assistance Income, or Food Stamps/SNAP in the Past 12 Months by Household Type for Children Under 18 Years in Households. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=B09010&g=0400000US23&tid=ACSDT1Y2019.B09010&hidePreview=true.
[32] U.S. Census Bureau. 2019 American Community Survey 1-Year Estimates. S2201: Food Stamps/Supplemental Nutrition Assistance Program (SNAP). Cited 3-23-21; Available from https://data.census.gov/cedsci/table?q=S2201&g=0400000US23&tid=ACSST1Y2019.S2201&hidePreview=true.
[33] Kaiser Family Foundation. State Health Facts. Average Monthly Food Stamp Benefits Per Person. FY 2017. Cited 3-23-21; Available from: https://www.kff.org/statedata/?state=ME.
[34] Kaiser Family Foundation. State Health Facts. School children eligible for subsidized school lunch in Maine. 2010-2020. Cited 3-23-21; Available from: https://datacenter.kidscount.org/data/tables/1566-school-children-eligible-for-subsidized-school-lunch#detailed/2/any/false/1729,37,871,870,573,869,36,868,867,133/any/12834,3339.
[35] U.S. Census Bureau. 2015-2019 American Community Survey 5-Year Estimates. DP04: Selected Housing Characteristics. Cited 3-23-21; Available from: https://data.census.gov/cedsci/table?q=DP04&g=0100000US_0400000US23,23.050000&tid=ACSDP5Y2019.DP04&hidePreview=true.
[36] Maine Housing Authority. 2020 Homeownership Affordability Indexes. Cited 3-23-21;
Available from: https://www.mainehousing.org/policy-research/housing-data/housing-affordability-indexes.
[37] Substance Abuse and Mental Health Services Administration. Homeless Youth. Cited 3-23-21; Available from: https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/youth.
[38] Maine State Housing Authority. Maine Homelessness Survey: 2019 Point in Time Count Cited 3-23-21; Available from: https://www.mainehousing.org/docs/default-source/housing-reports/2019-point-in-time-survey.pdf?sfvrsn=6d6fb415_4.
[39] U.S. Department of Housing and Urban Development Hud Exchange. CoC System Performance Measures Data Since FY 2015. 2020. Cited 3-10-20; Available from: https://www.hudexchange.info/resource/4483/system-performance-measures-tools/.
[40] The U.S. Department of Housing and Urban Development. The 2019 Annual Homeless Assessment Report (AHAR) to Congress. Cited 3-23-21; Available from: https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf
[41] National Association of Chronic Disease Directors. Covid-19 Resilience Dashboard. Accessed 7-26-21 from: https://chronicdisease.org/covid/.
[42] Maine Center for Disease Control and Prevention. COVID-19: Maine Data. Accessed 7-26-21 from: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/data.shtml
[43] National Centers for Disease Control and Prevention. COVID Data Tracker. Accessed 3-23-21 at: https://covid.cdc.gov/covid-data-tracker/#global-counts-rates.
44Barbara Bush Children's Hospital. About BBCH. Accessed 3-23-21 from: https://www.mainehealth.org/Barbara-Bush-Childrens-Hospital/About
45American Board of Pediatrics, Pediatric Physicians Workforce Data Book, 2019-2020, Chapel Hill, NC: American Board of Pediatrics, 2020. Accessed 3-23-21 from:
https://www.abp.org/sites/abp/files/pdf/workforcedata2019-2020.pdf
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