As Maine’s aging population grapples with complex health needs and rural hospitals struggle with workforce shortages, the state is looking for ways to modernize how health care services are offered in rural areas. What Maine needs, state officials wrote in a request for funding from the federal Rural Health Transformation Program, is “a new approach to delivering rural health care.” 

This will likely include the use of artificial intelligence, but exactly what that looks like remains to be seen.

The five-year, $50 billion Rural Health Transformation Program was congressional Republicans’ last-minute addition to President Donald Trump’s Big Beautiful Bill Act last summer –– an attempt to address the fallout over the bill’s call to cut Medicaid spending by more than $900 billion over 10 years. 

Maine is set to receive $190 million from the program in year one and has said it plans to use the money to recruit more health care workers in rural areas, strengthen community-based care, reduce transportation-related barriers, support regional collaboration and more. It was also originally hoping to use some of the funds to help hospitals and clinics pay for low-income, uninsured patients’ treatment. But the Centers for Medicare and Medicaid, which oversees the Rural Health Transformation Program, said no, KFF Health News reported.

CMS, with Dr. Mehmet Oz at the helm, has pushed states to use the money for “bold, creative plans,” including the use of new technologies. 

“President Trump is determined to end the hemorrhaging of rural hospitals, and he’s asked me to do that through the use of AI, through telemedicine,” Health and Human Services Secretary Robert F. Kennedy Jr. told a Senate committee last year, describing an “AI nurse that you cannot distinguish from a human being.”

Maine’s proposal includes spending $200 million over the five years to improve technology used by rural health care providers, such as upgrading electronic medical record systems and expanding telehealth services.

It also mentions plans to “create a Maine Rural AI Hub to support rural providers in adopting today’s AI technologies and establish a Rural Health AI Innovation Institute to promote development of new AI technologies purpose-built for rural populations.” 

But it offers few details about what this will entail or what sorts of AI technologies will be pursued. 

A spokesperson for the Maine Department of Health and Human Services, which is overseeing the state’s program, declined to comment on the plans for an AI Hub, writing in an email that it is in the “very early phases.”

AI encompasses a broad swath of technologies that use algorithms and large data sets to identify patterns and generate information that would otherwise require human intelligence, from text summaries and audio transcriptions to more complex outputs. It is used in many health care settings to streamline administrative work, such as through programs that record appointments and generate notes, and as a diagnostic tool, such as by analyzing X-rays. 

“While these advances offer considerable promise, the adoption of AI in health care also raises critical concerns,” the authors of a policy brief for The National Rural Health Association wrote in December. “Issues of data quality, limited training data, user privacy, accessibility, ethical and legal questions, and community engagement all present challenges to widespread implementation.”

The state’s proposal calls for the creation of a Maine Rural AI Hub through a partnership with Duke University, saying it will “provide expertise, oversight, and guidance to assist rural healthcare organizations to establish effective local governance models needed to accelerate and manage AI adoption in their clinical and business functions.”

Separately, the proposal calls for establishing a Rural Health AI Innovation Institute, budgeting $500,250 in its first-year plan.

Exploring the use of AI in rural health care delivery and establishing Maine as an “innovation hub” were among recommendations the Maine Artificial Intelligence Task Force made in a report published last fall.

“Across the state, health systems are already deploying AI tools such as ambient documentation, remote patient monitoring, and AI-assisted diagnostics, with early results showing gains in provider retention, reduced employee burnout, and more accurate and timely diagnoses,” the report said.

Spokespeople for Duke University did not respond to requests for additional information. On its website, Duke’s Health AI Partnership describes itself as a collaborative that seeks to help health care organizations use AI “safely, effectively, and ethically.”

The state has selected Hallowell-based MCD Global Health as its “technology and innovation partner” for the program, according to a July 29 press release. It is currently accepting applications for about $30 million in funding that will go to helping health care providers upgrade their electronic medical record systems; its website lists requests for proposals from digital health and AI providers as “coming soon.” A spokesperson for MCD Global Health did not respond to a request for an interview.

Noah Nesin, a family medicine physician who serves on the board of the Maine Public Health Association, learned of the state’s plans for a Rural AI Hub through his work with an accountable care organization that reviewed and gave feedback on Maine’s application. He said there are both pros and cons to consider.

“There are very significant privacy concerns around the use of AI and there’s very dramatic potential around the use of AI,” he said.

Some of these concerns revolve around whether patients’ medical records will be used to train the AI systems.

But for small, rural practices that do not have the benefit of a deep roster of experts or administrative help that a large, urban practice might have, AI could be a boon, Nesin said.

He pointed to an application called OpenEvidence, an AI-powered tool trained on medical literature intended to help providers make decisions without having to search through medical journals.

AI can also identify particular population groups that need more attention from providers –– people who are at higher risk of hospitalization, for example, that would benefit from more proactive outreach and intervention. And it can assist providers by cutting down the time they have to spend on administrative tasks, he said.

Rebecca Boulos, MPHA’s executive director, echoed Nesin’s concerns around privacy.

Providers need to get patients’ consent to use AI and be clear with patients about how their data will be used, who will have access to it and what oversight exists, she said, noting that many people are skeptical of AI and skeptical of the health care system.

She also raised questions about the potential infrastructure needs that the increased use of AI could require, such as large data centers.

“If you’re going to have a conversation about AI in health care or in public health, it has to be within the context of ‘What do we need to facilitate the use of AI?’” Boulos said. “Whether that infrastructure is broadband or a data center –– looking at resource demands, looking at land use, looking at community input and buy-in.”

This story was originally published by The Maine Monitor, a nonprofit civic news organization. To get regular coverage from The Monitor, sign up for a free Monitor newsletter here.