Maine has a long history of effectively addressing public health issues and improving health outcomes of the MCH population. Over the last 20 years Maine reduced rates of smoking during pregnancy and births among adolescents. 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 MCH in Maine.

Another strength of Maine’s public health system is 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.

Despite our many strengths there remain challenges to improving the health of Maine people. There are significant gaps in health-related services especially in Maine’s more rural counties. These services include labor and delivery units, behavioral health and other medical providers. Currently only 22 of Maine’s 33 hospitals provide labor and delivery services. Since 2017 five Maine hospitals have closed their obstetric units. Many rural areas in Maine are underserved for primary care, dental care, mental health and substance use providers. The lack of providers in rural areas translates to families having to drive long distances to receive services or not accessing them at all.

In addition, 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 2021 (LD 1484) establishing the Maine Connectivity Authority (MCA) to expand broadband using American Rescue Plan Act funding. In January 2023 the MCA awarded $34 million in grants to 31 communities across nine counties to provide broadband services in many of Maine’s most rural areas.

Maine CDC Role in Delivery of Title V Services

The Maine CDC is responsible for providing essential public health services that preserve, promote and protect the health of the State’s population. The Maine CDC delivers MCH-related services and acts as a liaison between State offices and Departments, providers, and consumers. The Maine Department of Health and Human Services (Maine DHHS) also includes the Office of MaineCare Services (OMS), the Office of Child and Family Services (OCFS), the Office of Behavioral Health, the Office of Family Independence and Licensing and Certification. Having these offices under the same umbrella agency has helped to facilitate improved delivery of Title V services. For example, our collaboration with MaineCare has helped improve services for pregnant persons with substance use disorder and our collaboration with OCFS has improved care for infants born substance exposed.

Systems of Care

Maine’s systems of care for meeting the needs of underserved and vulnerable populations span several Maine DHHS offices including Maine CDC and OMS. Maine CDC houses Public Health Nursing (PHN), WIC, and Children with Special Health Needs (CSHN). There are no eligibility requirements for PHN, however MaineCare and WIC serve clients who meet Medicaid income guidelines, as well as other eligibility criteria. OMS provides medical and dental insurance and WIC ensures food security to vulnerable families. They play an important role in prenatal care by ensuring proper nutrition for infant growth and ensure women seek medical care when necessary. The WIC program provides breast pumps for nursing mothers, formula, when needed, for babies as well as 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.

In 2022, OCFS launched Help Me Grow (HMG) in Maine. This statewide referral system for children up to age eight and their families connects families to services for child development and community resources in partnership with 2-1-1 Maine.

Maine’s CradleME referral system, HMG and other partners are part of Maine’s Early Childhood Comprehensive Systems (ECCS) Initiative. Maine received a ECCS grant in 2022 and is working to build partnerships and engage families in building a system for children and families from the prenatal to early childhood period that ensures comprehensive, equitable, and coordinated care for all families.

Maine’s Community Health Centers play a vital role in keeping our states rural MCH population healthy. These safety net providers provide medical, dental, behavioral health and other enabling services such as transportation. In 2021 Community Health Centers in Maine served over 38,000 children (https://www.nachc.org/wp-content/uploads/2023/03/StateFactSheet_ME_2023-1.pdf).

Pediatric Care Capacity

Maine has one children’s hospital, Barbara Bush Children's Hospital at Maine Medical Center, located in Portland. It has 116 beds, including 31 Level III NICU Beds, 20 Level II Continuing Care Nursery beds and 8 PICU beds.

The American Board of Pediatrics tracks the number of diplomates (i.e., pediatricians who passed the General Pediatrics Certifying Examination) currently in the pediatric workforce. As of February 2023, there were 231 general pediatricians, representing a ratio of 1,091 children per pediatrician. However, this ratio varies significantly by county. In Maine’s rural Washington County there is one pediatrician for 5,970 children and in Somerset county there is one pediatrician for 9,358 children (https://www.abp.org/dashboards/general-pediatricians-us-state-and-county-maps).

Subspeciality pediatric care is also a challenge with families needing to travel long distances to access pediatric subspeciality care. For example, on average, families in Maine need to travel more than 50 miles for pediatric rheumatology, nephrology, allergy and immunology, and pulmonology care (https://downloads.aap.org/AAP/PDF/Advocacy/Maine_SubspecialtyFactSheet.pdf?_ga=2.95097564.131367219.1680878094-1163616198.1680878094).

Maine DHHS placed an emphasis on integrating physical, social and behavioral health services to ensure greater access to services and ensure the services are effectively coordinated. Maine Title V contracts with the largest hospital system to provide clinics for children who have a cleft lip and/ or palate. The clinic is 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 clinic 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 and in January of 2019 Governor Janet Mills approved the plan to fund the expansion. As of February 1, 2023, 106,509 people were enrolled through the MaineCare expansion, including 92,884 adults without children, as well as 13,625 parents and caretaker relatives.[1]  OMS estimates that 65,000-90,000 individuals may lose MaineCare coverage due to the Consolidated Appropriations Act. Maine DHHS is working to minimize the number of people who lose their coverage by partnering with communities across the state to inform people that changes are coming and what they need to do to stay covered. Maine DHHS will send mail, text message and email reminders to all members regarding the need to complete renewals and has contracted with more than a dozen Community-Based Organizations across the state to spread the word https://www.maine.gov/dhhs/news/maine-dhhs-launches-campaign-promote-continued-health-coverage-medicaid-eligibility-reviews-resume-tue-03072023-1200 . 

Geography

Maine is the northernmost and largest state in New England and the easternmost state in the U.S. 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 2022, 1.39 million people residing in the state of Maine.[2] Between 2020-22 Maine's overall population increased 1.7% compared to 0.6% nationally. During this time Maine’s population growth exceeded that of the other New England states and was 14th highest in the U.S.[3] Much of this increase was likely due to an influx of people moving to Maine during the COVID-19 pandemic. During this period there were more deaths than births (-11,179 people) however domestic migration (+30,642) and international migration (+3,595) resulted in higher than average population growth and increased racial and ethnic diversity in the state.[4] In contrast, net natural increases caused 23% of the U.S. population increase in this period.4

Maine has three metropolitan (metro) areas; Portland-South Portland (pop. 556,893), Lewiston-Auburn (pop.111,034) and Bangor (pop.152,765).[5] Collectively 59.8% of Maine's population resides in these three metro areas5 (compared to 80% of U.S. residents who live in metro areas).[6] More than one third (37.8%) of Maine's population lives in the two southernmost counties (Cumberland and York)5 that account for only 6% of the state's land area.[7]

The average population density of Maine is 43.1 people/ square mile compared to 87.4 people/ square mile in the U.S.6 However the population density of Maine varies dramatically across the state from 337 people/ square mile in Cumberland County where Maine's largest city (Portland) is located to four people/ square mile in Piscataquis County.6

The median age of Maine's population (44.7 years) is more than five years older than the U.S. (38.8 years) and is the highest in the country.[8] Maine saw a very small decrease in our median age between 2020 and 2021. We were the only state whose median age decreased between these years (https://www.census.gov/newsroom/press-releases/2022/population-estimates-characteristics.html?utm_campaign=20220630msprts1ccpupnl&utm_medium=email&utm_source=govdelivery). As of 2018, for the first time, the percentage of Maine’s population aged 65 and older equaled the proportion of the population aged 19 and younger (21%). Maine’s State Economist projects that by 2036, 32% of Maine's population will be age 65 and older and 17% will be 19 years and younger. That represents a 52% increase for the population 65 years and older and a 24% decrease for the population under the age of 19 between 2018 and 2038.[9] Maine is expected to experience an overall population increase of 2.3% between 2018 and 2038. Nine of Maine’s 16 counties are projected to have positive population growth in that time.9

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 2021 children under 18 years plus women ages 18-44 represented 39.8% of Maine's population.5 Children under 18 years comprised 18.2% of the state's population. Nationally children under age 18 comprised 22.1% of the population.5

In 2021 the median age of women in Maine was 45.8 years.8 Women aged 18-44 years comprised 21.6% of Maine's population compared to 24.1% nationally.5

Prevalence estimates of current disability or special health needs among Maine children differ depending on the definition used. According to the 2021 National Survey of Children’s Health there are nearly 54,000 children with special health care needs (CSHCN) in Maine, representing 22% of children under age 18. This is significantly higher than the percentage of CSHCN in the U.S. (19.3%).[10]

Demographics

Family

According to estimates from the 2017-21 American Community Survey the average household size in Maine is 2.3 people and the average family size is 2.9.[11] A quarter of households (24.8%) in Maine include one or more children under age 18 compared to 30.6% nationwide.11 Of the householders living with their own child under age 18, 14.6% are female-headed (no spouse/partner present) households and 5.1% are male-headed (no spouse/partner present) households[12]. About one third of Maine grandparents who are living with their grandchildren report being responsible for their grandchildren (34.1%).12 Of Maine women aged 15 and over 49.3% are currently married, 25.1% have never been married, 14.9% are divorced, 9.6% are widowed and 1.1% are separated.12 About a third (37.2%) of births in Maine are to unmarried women, similar to 35.5% nationwide.10

Racial and Ethnic Diversity

According to the 2017-21 ACS Maine's population is: 92.9% White, 0.6% American Indian or Alaska Native, 1.4% Black or African American, 1.1% Asian, 0.1% Native Hawaiian or Other Pacific Islander, 0.5% some other race, and 3.5% two or more races.[13] Of Maine's children under age 18, 88.3% are White, 2.5% are Black or African American, 0.8% are American Indian or Alaska Native, 0.0% are Native Hawaiian or Other Pacific Islander, 1.1% are Asian, 6.5% are two or more races, 0.8% are some other race, and 3.0% are Hispanic.[14] 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 about 5% (from 95.3% in 2010 to 90.5% as of 2019).[15]

Based on 2021 ACS data 23,720 (2.6%) Mainers identify as American Indian alone or in combination with one or more other races.15 There are four federally recognized Indian tribes consisting of five tribal communities in Maine: Aroostook Band of Micmac Indians, Houlton Band of Maliseet Indians, Passamaquoddy Tribe of Indian Township, Passamaquoddy Tribe at Pleasant Point, and Penobscot Indian Nation. Collectively the four Native tribes of Maine are known as Wabanaki, “People of the Dawn.”[16] 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).16

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.[17] The Aroostook Band of Micmac Indians is estimated to be more than 1,489 members.[18] The Houlton Band of Maliseet Indians is comprised of approximately 1,700 members.[19] An estimated 2,398 members comprise the Penobscot Nation population.[20]

In 2017-21, 3.6% of Maine residents were foreign-born; the proportion within Maine's counties ranged from 1.5% in Oxford County to 6.1% in Cumberland County.12 Of Maine's foreign-born population 26.6% were born in Asia, 24.4% in Europe, 19.3% in North America, 17.5% in Africa and 11.1% in Latin America.[21] Among Maine's foreign born 68.3% entered the U.S. before 2010.[22] About half (54.8%) of Maine's foreign-born are naturalized U.S. citizens.[23] Across Maine 5.9% of the population aged five and older spoke a language other than English at home; approximately 1.4% spoke English less than "very well."[24]

Emerging populations in Maine include people of Somalia, Sudan, Congo, Ethiopia, Burma, Iran and Iraq who are arriving in Maine as primary refugees or secondary migrants.[25] 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.[26] In FY22, 515 refugee arrivals were served by the Office of Maine Refugee Services; 52% were from Afghanistan (n=268), 9% were from Ukraine, and 39% were from other countries.[27]

Secondary migration is a legal term that refers specifically to refugees placed for resettlement initially in one location in the U.S. and decide to relocate to another part of the U.S. 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.25 In FY18 Catholic Charities Refugee and Immigration Services resettled approximately 66 primary refugees, assisted 40 secondary migrants and 41 asylees.25

In 2019 around 800 asylum seekers, primarily African, arrived in Portland Maine to await decisions on their status. Over $900,000 in federal funding and $900,000 in private donations were obtained to help settle the asylees in Portland and surrounding communities.[28] In January 2022 the city of Portland was still struggling to find permanent housing for many of those asylees (727 were still being housed in shelters or hotels).[29] More than 1,000 asylum seekers have arrived in Portland thus far in 2023 and the city is sheltering about 1,200 people per night. Portland opened a temporary shelter in April to house recent immigrants; (about 300 people per night).[30] This is only a temporary solution as housing prices in Portland are unaffordable for many making permanent housing difficult to find.

Educational Attainment

In 2017-21, 93.7% of Maine residents age 25 and over were high school graduates compared to 88.9% nationally.12 The county-specific proportion of high school graduates age 25 and older ranges from 90.4% in Aroostook County to 95.7% in Cumberland County.12 Although a slightly higher percentage of Maine residents over age 25 completed high school compared to the U.S., the percent with a bachelor’s degree or higher is similar (33.6% Maine vs 33.7% U.S.). Among adults age 25+, 12.6% have completed an advanced degree.12 Among Maine women, 96.0% of those age 25-34 and 96.5% of Maine women age 35-44 were high school graduates; both proportions were higher than those among women of these age groups in the U.S. (93.2% and 90.7%, respectively).[31]

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, childcare, 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 2023 for a two-parent (2-earner), two-child Maine family to meet their basic needs was $102,272 (a wage of $24.58/hour per adult).[32] The county-specific livable wage for this family type ranged from $93,226 ($22.41/hour per adult) in Piscataquis County to $113,144 ($27.20/hour per adult) in Cumberland County. For single-parent Maine families with two children the average annual income required is $78,856 ($37.91/hour) with county-specific estimates ranging from $73,083 ($35.14/hour) in Piscataquis County to $85,640 ($41.17/hour) in Cumberland County.32 The livable wage is considerably higher than both the federal poverty level (FPL) and the income of a minimum wage earner. As of January 2023, Maine's $13.80 per hour minimum wage is $6.55 higher than the federal standard of $7.25.[33] Maine has the 9th highest minimum wage in the U.S., and the third highest in New England. In Maine a full time year-round minimum wage worker will earn $552/week or $28,704/year. In 2023 the FPL for a family unit consisting of two people is $19,720/year. The FPL for a family of four is $30,000.[34] 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 2021 median household income is $4,950 less than the U.S. median ($64,767 vs. $69,717).[35] There is considerable variation in income across Maine counties. In 2017-21 the median household income ranged from $46,948 in Piscataquis County to $80,679 in Cumberland County.[36]

According to the 2017-21 ACS 14.9% of Maine people are at or below 125% FPL, 11% are at 100% FPL and 4.5% are at or below 50% FPL.[37] Poverty is inversely related to educational attainment; 25.5% of those with less than a high school diploma are below 100% FPL compared to 13.3% of high school graduates, 8.9% of those with some college, and 4.3% of those with a bachelor's degree or higher.37

The poverty rate among Maine children under age 18 is 13.8%.37 The county-specific proportions of children under age 18 below 100% FPL ranged from 8.6% in Cumberland County to 23.9% in Washington County and 23.2% in Somerset County.37 Among female-headed households with children under age18, 31.3% lived in poverty (vs 33.6% U.S.) in 2017-21.[38] Among families with children under age five 11.6% lived below poverty, and 39.3% of female-headed households with children under five lived in poverty in 2017-21; this is similar to households in the U.S. (37.8%).38

Labor Force and Employment

Maine's civilian labor force was estimated at 673,400 in February 2023.[39] In Maine 62.9% of adults aged 16 and over are in the labor force; this proportion ranges from 50.6% in Piscataquis County to 69% in Cumberland County.36 In the U.S. 63.6% of the population is in the labor force. The proportion of children under age 6 with all parents in the labor force is 69.6% in Maine and ranges from 51.1% in Franklin County to 79.8% in Sagadahoc County.36 Among women ages 16 or older 59.6% are in the civilian labor force.36 Median earnings for women working full time year-round in 2021 were 82% of men’s earnings ($47,018 vs. $57,009).[40]

The February 2023 seasonally adjusted unemployment rate for Maine was 2.8%, down 0.4% from the same period last year.39 Unemployment figures do not reflect the number of underemployed and those who became discouraged and stopped looking for work. Maine’s unemployment rate hit a high of 9.4% in May 2020 which is likely due to the COVID-19 pandemic. A similar trend was seen nationally. It declined rapidly since that time and Maine’s March unemployment numbers are the lowest the state has seen in at least 15 years. 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, transportation, agriculture, and public administration sectors.35

Income Assistance

In 2021 approximately 21.6% 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;[41] this proportion varied by family type. Of children living in families receiving one of these programs, 42% were living in married couple family households, 12.4% were living in a male-headed household, 45.4% were living in female-headed households.41 SNAP assistance is one of the most wide-spread low-income benefit programs in Maine. According to 2021 data approximately 11.5% of Maine's households were receiving SNAP.[42] The median household income of SNAP recipients in 2020 was $21,427.42 The monthly benefit per person in FY22 averaged $244.This is the 15th highest in the U.S. but lower than all but one New England state.[43] Maine’s WIC program served, on average, 16,847 participants each month during FY22.[44] This is an increase since FY21 but enrollment in WIC had been decreasing annually over the past five years. This is a consistent trend across states. It may be partially due to declining birth numbers. During the 2021-22 school year 34.9% of Maine schoolchildren were eligible for the free and reduced meals program.[45] During the COVID-19 pandemic the federal government created a waiver allowing all students to receive free lunch; this waiver was extended through the 2021-22 school year. In 2021 Maine’s governor signed a budget bill that required schools to continue to provide free school meals to all students starting in the 2022-23 school year. Maine was the second state in the U.S. to pass a law similar to this.[46]

Housing

According to 2017-21 ACS data, 77.4% of Maine's housing units are occupied. This is significantly lower than the U.S. (88.8%).[47] Among Maine's 569,551 occupied housing units, 73.4% are owner-occupied and 26.6% are renter occupied.47 The median gross monthly rent is $927.00. Among renter-occupied units 35.5% consume more than 35% of renters’ household income.47 Among owner-occupied units 60.5% have mortgages and of those with mortgages 19.2% have housing costs which consume 35% of the owners’ household income.47

Among Maine's occupied housing units 6.8% have no vehicles available, 33% have one vehicle and 60.2% have two or more vehicles available; 1.1% of occupied housing units have no telephone service available.47 Of Maine's occupied housing units 70.3% are detached single-unit structures and 8.3% are mobile homes. Over a quarter of housing units (23.7%) were built before 1940; in the U.S.12% of housing units were built before 1940.47

Finding affordable housing is a challenge for some Maine residents. According to a 2022 Maine State Housing Authority (MSHA) Homeownership Affordability Index the median price of homes increased 76% between 2016 and 2022 ($189,900 to $334,000).[48] Maine's median income increased 34% during the same period.48 Currently the most affordable communities are in the more rural counties in the state (Aroostook, Piscataquis, Somerset and Washington) with the least affordable in the southern and coastal areas.48 Statewide about 71.9% of Maine households are unable to afford a median home price and 55% cannot afford the rent for an average two-bedroom apartment ($1,088).[49]

Homelessness

According to the U.S. Department of Housing and Urban Development’s 2022 Annual Homeless Assessment Report, “Homeless describes a person who lacks a fixed, regular, and adequate nighttime residence.” That report estimated 4,411 individuals in Maine were homeless and 164 unsheltered on a single night in January 2022. Although Maine’s homelessness rate is one of the lowest in the U.S., Maine had one of the largest percent increases in homelessness between 2020 and 2022 (110% increase).[50] Of Maine’s homeless population 1,954 were people in families with children (44%), an increase of 142% between 2020 and 2022; 209 were unaccompanied homeless youth, a 50% increase between 2020-22.53 Nationally, about a third of the homeless population is less than age 24.[51] Compared to children with stable housing, homeless children are more likely to have health problems, developmental delays, learning disabilities, emotional difficulties, and mental disorders.50

On January 22, 2022 the MSHA Point in Time Survey identified 3,291 homeless individuals in shelters. This was a significant increase compared to prior years because individuals staying in hotels funded by General Assistance and the Emergency Rental Assistance Program were included for the first time.[52] Of those surveyed, 767 had a mental illness, 342 were victims of domestic violence, and 425 had a substance abuse problem. 24% of homeless people were under age 18, and 42% were female.51 In FY21 the average number of nights spent in a shelter per person was 80; the median was 49.[53]

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. While some of those restrictions were lifted in 2021 many businesses and schools continued to require vaccinations and masking and many employees continued to work remotely. During 2022 many of the restrictions were lifted as both COVID-19 testing, and vaccinations were accessible to all.

Pandemic-related restrictions, fears, and logistical challenges have taken a toll on people’s health. Based on surveys of adults conducted quarterly since January 2021, as of October 2022, 15% of adults said that childcare or dependent care prevented them from seeking healthcare since June 2020; 11% of Mainers said that a fear of contracting the virus prevented them from seeking healthcare (this is a decrease from 34% in January 2021); 18% said that they had worse diet habits during the pandemic and 26% said they had worse exercise habits during the pandemic.[54]

As of April 2023, Maine’s cumulative COVID-19 case count was 322,043.[55] This is likely an underestimate of total cases due to the use of home COVID-19 tests. Maine’s weekly case rate as of April 19, 2023 was 23.3 per 100,000.  This was lower than the US weekly case rate of 28.4 per 100,000.[56] Maine has 2,998 cumulative deaths and 7,376 hospitalizations from COVID-19.55 The burden of COVID-19 infections has not been felt equally by all populations. While Black or African American Mainers make up less than 1.4% of the population, they represent 3% of the confirmed cases.55 The vast majority of deaths (46%) have been among those age 80+. Cumulative case rates are lowest in Maine’s rural counties with the lowest 7-day case rate in Somerset County (13.9 cases/100,000 population). The highest 7-day case rate was in Oxford County (77.6 cases/100,000 population).55

Between March 12, 2020 and March 28, 2022 a total of 101,009 COVID-19 cases were reported among youth aged 0-18 (21.6% of all cases).[57] Data gathered from COVID-19 case investigations shows 211 COVID-19 cases in children and youth age 0-24 resulted in hospitalization, although this number is likely an underestimation since only a small proportion of cases reported are investigated.58

COVID-19 during pregnancy has been recorded in birth records from the medical record since June 1, 2020. Between 2020 and 2023 there have been 4,252 confirmed cases of COVID-19 among Maine residents who gave birth in Maine.[58]

As of April 2023, 76.5% of all Mainers were fully vaccinated against COVID-19.[59] Vaccination rates remain low among children age 0-4 (13.8%) and 5-11 (45.5%) and higher in children age 12-19 (71.0%). Maine’s more rural and northern counties have lower vaccination rates compared to coastal and southern counties. Vaccination (2 doses) rates across Maine counties range from 63.0% in Somerset County to 87.7% in Cumberland County.59

Statutes relevant to the Title V Program

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. February 1, 2023. Accessed 04/06/23 from: https://www.maine.gov/dhhs/data-reports/mainecare-expansion.

[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, 2020 to July 1, 2022 (NST-EST2022-POP). https://www2.census.gov/programs-surveys/popest/tables/2020-2022/state/totals/NST-EST2022-POP.xlsx

[3] US Census Bureau, Population Division. Annual and Cumulative Estimates of the Resident Population for the United States, Regions, States, the District of Columbia, and Puerto Rico and Region and State Rankings: April 1, 2020 to July 1, 2022 (NST-EST2022-CHG). https://www2.census.gov/programs-surveys/popest/tables/2020-2022/state/totals/NST-EST2022-CHG.xlsx

[4] U.S. Census Bureau. Annual and Cumulative Estimates of the Components of Resident Population Change for the United States, Regions, States, and Puerto Rico: April 1, 2020 to July 1, 2022. (NST-EST2022-COMP). Available from: https://www2.census.gov/programs-surveys/popest/tables/2020-2022/state/totals/NST-EST2022-COMP.xlsx.

[5] U.S. Census Bureau. 2021 American Community Survey 1-Year Estimate. Table S0101 Age and Sex. Cited 04-06-23. Available from: https://data.census.gov/table?q=age&g=310XX00US12620,30340,38860&tid=ACSST1Y2021.S0101

[6] U.S. Census Bureau. 2020 Census Urban Area Facts. https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural/2020-ua-facts.html

[7] 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.

[8] U.S. Census Bureau. 2021 American Community Survey 1-Year Estimates. Table B01002 Median Age by sex. Cited 4-11023. Available from: https://data.census.gov/table?text=median+age&tid=ACSDT1Y2021.B01002

[9] Maine State Economist. Maine State and County Population Projections 2038. Cited 4/12/2; Available from: https://www.maine.gov/dafs/economist/demographic-projections.

[10] National Survey of Children’s Health, 2021. Data Resource Center for Child and Adolescent Health. Cited 4/12/23; Available from: https://www.childhealthdata.org/browse/survey/results?q=9984&r=21&r2=1

[11] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. S1101: Households and Families. Cited 4/13/23 Available from: https://data.census.gov/table?q=family+size&g=010XX00US_040XX00US23&tid=ACSST5Y2021.S1101.

[12] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. DP02: Selected social characteristics in the United States. Cited 4/13/23 Available from: https://data.census.gov/cedsci/table?q=selected%20social%20characteristics&g=0100000US_0400000US23&tid=ACSDP5Y2019.DP02.

[13] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. ACS DEMOGRAPHIC AND HOUSING ESTIMATES. Table DP05. Cited 4/13/23; Available from: https://data.census.gov/cedsci/table?t=Age%20and%20Sex&g=0100000US_0400000US23&tid=ACSDP5Y2021.DP05.

[14] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. CHILDREN CHARACTERISTICS. Table S0901. Cited 4/13/23; Available from: https://data.census.gov/cedsci/table?q=S0901&g=0400000US23&tid=ACSST5Y2021.S0901.

[15] U.S. Census Bureau. 2010 & 2021 American Community Survey 1-Year Estimates. ACS Demographic and Housing Estimates. Table DO05. Cited 4/13/23; Available from: https://data.census.gov/table?t=Age+and+Sex&g=040XX00US23_010XX00US&tid=ACSDP1Y2010.DP05; https://data.census.gov/table?t=Age+and+Sex&g=040XX00US23_010XX00US&tid=ACSDP1Y2021.DP05;

[16] 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/.

[17] Passamaquoddy Tribe at Indian Township. Our People. Cited 4/14/23; Available from: https://www.passamaquoddy.com/?page_id=14.

[18] Aroostook Band of Micmacs. Official Website of Aroostook Band of Micmacs. 2018. Cited 4/14/23; Available from: http://www.micmac-nsn.gov/.

[19] Houlton Band of Maliseet Indians. Houlton Band of Maliseet Indians: About Us. 2010. Cited 4/14/23; Available from: http://www.maliseets.com/index.htm.

[20] Penobscot Indian Nation. Cited 4/14/23; Available from: http://www.penobscotculture.com/index.php/8-about/81-tribal-facts.

[21] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. Place of Birth for the Foreign-Born Population in the United States. Table B05006. Cited 4/13/23; Available from: https://data.census.gov/table?q=place+of+birth&g=010XX00US_040XX00US23&tid=ACSDT5Y2021.B05006

[22] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. Selected Characteristics of the Foreign-born Population by Period of Entry into the United States. Table S0502. Cited 4/13/23; Available from: https://data.census.gov/table?q=foreign+born&g=010XX00US_040XX00US23&tid=ACSST5Y2021.S0502

[23] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. Place of Birth by Nativity and Citizenship Status. Table B05002. Cited 4/13/23; Available from: https://data.census.gov/table?q=foreign+born&g=010XX00US_040XX00US23&tid=ACSDT5Y2021.B05002

[24] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. Languages Spoken at Home. Table S1601. Cited 4/13/23; Available from: https://data.census.gov/table?q=language&g=010XX00US_040XX00US23&tid=ACSST5Y2021.S1601

[25] Catholic Charities of Maine. FAQ’s: Who are the New Mainers? Cited 3/22/22; Available from: https://www.ccmaine.org/refugee-immigration-services/faqs.

[26] 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.

[27] Catholic Charities, Office of Maine Refugee Services. Data and Statistics. End of FY22 All Arrivals September 30th. https://www.ccmaine.org/omrs/data-and-statistics

[28] 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/.

[29] News Center Maine. “City of Portland, social services organizations overwhelmed by surging number of asylum seekers.” Cited 3-22-22. Available from:  https://www.newscentermaine.com/article/news/local/maine-immigration/portland-social-services-organizations-overwhelmed-by-surging-number-of-asylum-seekers/97-e739aacd-6b5b-4651-bc9d-bb9b756b4998.

[30] White P. Maine city reopens arena to hundreds of asylum seekers. AP News, April 10, 2023. Cited 4/13/23. https://apnews.com/article/asylum-seekers-shelter-maine-immigration-0278c0e8f96d31f2a394c6bb5d15dd4b

[31] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. S1501: Educational Attainment. Cited 4/13/23; Available from: https://data.census.gov/cedsci/table?q=S1501&g=0100000US_0400000US23&tid=ACSST5Y2021.S1501

[32] Massachusetts Institute of Technology. Livable Wage Calculator. 2023. Cited 4/14/23; Available from: http://livingwage.mit.edu/states/23/locations.

[33] U.S. Department of Labor. Minimum Wage Laws in the States – January, 2023. Cited 4/14/23; Available from: https://www.dol.gov/whd/minwage/america.htm.

[34] U.S. Department of Health and Human Services and Assistant Secretary for Planning and Evaluation. 2023 HHS Poverty Guidelines. Cited 4/14/23; Available from: https://aspe.hhs.gov/poverty-guidelines

[35] U.S. Census Bureau. 2021 American Community Survey 1-Year Estimate. Table DP03. Selected Economic Characteristics. Cited 4/14/23; Available from: https://data.census.gov/table?q=DP03&g=040XX00US23_010XX00US&tid=ACSDP1Y2021.DP03

[36] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimate. Table DP03. Selected Economic Characteristics. Cited 4/21/23; Available from: https://data.census.gov/table?q=DP03&g=010XX00US_040XX00US23,23$0500000&tid=ACSDP5Y2021.DP03

[37] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. S1703: Selected Characteristics of People at Specified Levels of Poverty in the Past 12 Months. Cited 4/21/23; Available from: https://data.census.gov/table?q=S1703&g=040XX00US23$0500000,23_010XX00US&tid=ACSST5Y2021.S1703

[38] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. S1702: Poverty Status in the Past 12 Months of Families. Cited 4/21/23; Available from: https://data.census.gov/table?q=S1702&g=040XX00US23_010XX00US&tid=ACSST5Y2021.S1702

[39] Maine Center for Workforce Research and Information. Unemployment and Labor Force. Cited 4/21/23; Available from: https://www.maine.gov/labor/cwri/laus.html.

[40] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. S2001:Earnings in the Past 12 Months (In 2021 Inflation-Adjusted Dollars). Cited 4/21/23; Available from: https://data.census.gov/table?q=median+earnings&g=040XX00US23&tid=ACSST1Y2021.S2001

[41] U.S. Census Bureau. 2021 American Community Survey 1-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 4/21/23; Available from: https://data.census.gov/table?q=B09010&g=040XX00US23&tid=ACSDT1Y2021.B09010.

[42] U.S. Census Bureau. 2021 American Community Survey 1-Year Estimates. S2201: Food Stamps/Supplemental Nutrition Assistance Program (SNAP). Cited 4/21/23; Available from https://data.census.gov/cedsci/table?q=S2201&g=0400000US23&tid=ACSST5Y2021.S2201.

[43] Kaiser Family Foundation. State Health Facts. Average Monthly Food Stamp Benefits Per Person. FY 2022. Cited 4/21/23; Available from: https://www.kff.org/other/state-indicator/avg-monthly-snap-benefits/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[44] USDA Food and Nutrition Service. Annual State Level Data. Cited 4/21/23. Available from: https://www.fns.usda.gov/pd/wic-program.

[45] Kids Count Data Center. School children eligible for subsidized school lunch in Maine. 2010-20222. Cited 4/21/23; 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.

[46]News Center Maine. New law will require Maine public schools to provide free meals to all students. July 13, 2021. Cited 4/21/22. Available from: https://www.newscentermaine.com/article/news/local/as-seen-on-tv/new-law-requires-free-school-meals-for-all-maine-public-students-regardless-of-family-income-starting-2022-2023/97-4e822474-cd25-4641-958e-c0c8599971c3

[47] U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. DP04: Selected Housing Characteristics. Cited 4/21/22; Available from: https://data.census.gov/cedsci/table?q=DP04&g=0100000US_0400000US23,23%24050000&tid=ACSDP5Y2021.DP04.

[48] Maine Housing Authority. 2022 Homeownership Affordability Indexes. Cited 4/21/23;

Available from: https://www.mainehousing.org/policy-research/housing-data/housing-affordability-indexes.

[49] Maine Housing Authority. 2020 Rental Housing Affordability Indexes. Cited 4/21/23;

Available from: https://www.mainehousing.org/policy-research/housing-data/affordability-indexes.

[50] The U.S. Department of Housing and Urban Development. The 2022 Annual Homeless Assessment Report (AHAR) to Congress. Cited 4/21/23; Available from: https://www.huduser.gov/portal/sites/default/files/pdf/2022-AHAR-Part-1.pdf

[51] Substance Abuse and Mental Health Services Administration. Homeless Youth. Cited 4/21/23; Available from: https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/youth.

[52] Maine State Housing Authority. Maine Homelessness Survey: 2022 Point in Time Count Cited 4/21/23; Available from: https://www.mainehousing.org/policy-research/research-reports.

[53] U.S. Department of Housing and Urban Development Hud Exchange. CoC System Performance Measures Data Since FY 2015. Cited 4/21/23; Available from: https://www.hudexchange.info/resource/5691/system-performance-measures-data-since-fy-2015/

[54] National Association of Chronic Disease Directors. Covid-19 Resilience Dashboard. Accessed 4/24/23 from: https://chronicdisease.org/covid/.

[55] Maine Center for Disease Control and Prevention. COVID-19: Maine Data. Accessed 4/26/23 from: https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/data.shtml

[56] National Centers for Disease Control and Prevention. COVID Data Tracker. Accessed 4/23/23 at: https://covid.cdc.gov/covid-data-tracker/#global-counts-rates.

[57] Maine Center for Disease Control and Prevention. COVID-19 in Youth and Young Adults in Maine. Accessed 4/28/23 at https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/documents/COVID-19-Youth-4-24-2023.pdf.

[58] Maine Center for Disease Control and Prevention, Data, Research, and Vital Statistics Program. Data received 5/12/23.

[59] Maine Center for Disease Control and Prevention. COVID-19 Vaccination Dashboard. Accessed 4/28/23 at https://www.maine.gov/covid19/vaccines/dashboard.