Adapted from the National Center for Farmworker Health.
BACKGROUND
Farmworkers are a mobile, high-risk, high-need, and hard-to-reach working poor population thought to have the worst overall health status in the nation. Although eligible to participate in safety net programs, including Medicaid and the State Child Health Insurance Program (SCHIP), farmworkers under-utilize these programs. The low rate of farmworker participation is due to health systems problems in the regulation and administration of child health insurance programs that make it difficult for farmworkers to obtain or retain access to benefits.
State regulatory policies often contribute to the problem by failing to accommodate the special access needs of farmworkers in their planning processes. Farmworkers could benefit greatly from the outreach and enrollment effort currently surrounding the SCHIP. However, special efforts to remove access barriers are required at the national, state and community levels if the enrollment efforts are to be successful in allowing farmworker participation in both the SCHIP and Medicaid programs.
In 1998, The National Center for Farmworker Health, Inc. (NCFH) received funding from the HRSA Bureau of Maternal Child Health to implement a three-tiered program to remove barriers and increase farmworker participation in SCHIP and Medicaid. At the community level, the NCFH provides technical assistance to migrant and community health centers and other local social service organizations as well as SCHIP/Medicaid screening/referral to migrant farmworkers through its toll-free line, Call for Health. A collection of case histories of actual farmworkers cases is also being collected through the Call for Health Program to illustrate the barriers and challenges faced by the farmworker population as they attempt to participate in these programs.
At the state level, the NCFH is working with Primary Care Associations and Organizations (PCAs and PCOs) and the Bureau of Primary Care Migrant Health Branch to collect information regarding farmworker participation in these programs and identify barriers within specific states to assist state leaders in addressing these issues. In addition, NCFH conducts presentations to assist states in identifying where the issues lie (local, state or national level). One of the key strategies for impacting and overcoming the barriers to farmworker participation in SCHIP and Medicaid is the understanding of the barriers and at which level they can be impacted. In pursuit of this understanding, NCFH has developed the Removing Barriers for Farmworkers: Access to SCHIP and Medicaid Curriculum, and has developed two fact sheets (one for providers and the other a bilingual fact sheet for farmworkers). These materials are available through both our website and through the NCFH Resource Center. Both the curriculum and the fact sheets may be downloaded and copied for distribution.
The national level involves the formulation of federal recommendations based on the experiences and results obtained from the work completed at the community and state levels, as well as work with other national organizations.
For more information, contact Sylvia Partida (partida@ncfh.org).
Current state of efforts to improve access to SCHIP and Medicaid for farmworkers
CALIFORNIA:
The California model is focused on:
- Establishing portability of Medicaid within the State of California.
- Establishing reciprocity between California, Oregon and Washington.
Status of Intra-State Portability:
“The California Department of Health Services has agreed in meetings with CPCA that the current Medi-Cal intercounty transfer process is burdensome and unnecessarily complex for Medi-Cal beneficiaries including farmworkers. DHS officials are sending out a preliminary letter to counties, instructing them of the new policy to bring the state into compliance with federal law. CPCA advocated for a provision in this letter to allow migrant farmworkers who are temporarily moving to simply submit a change in address when they move, rather than having their case transferred to the new county; thereby eliminating portability barriers.
Other issues regarding intercounty transfers, especially for those migrants who are not moving temporarily and for those in managed care, will be resolved this year via the DHS Workgroup on Intercounty Transfers and the Advisory Committee on Medi-Cal Managed Care.” (CPCA Policy Team, 2002, Medicaid Portability for Migrant Workers).
Status of Inter-State Portability:
"Just recently, California’s Governor has committed to improving the health of migrant farmworker children by resolving portability barriers for children migrating into California via presumptive eligibility. The development of presumptive eligibility within the Child Health & Disability Prevention (CHPD) program will ensure that farmworker children are covered with full-scope Medicaid coverage for 60 days while their applications are being processed. Because California has higher eligibility levels than other states, the vast majority of these farmworker children will be found eligible to continue their Medicaid Coverage.” (Letter from Vivian Huang, CPCA Policy Analyst, to Elizabeth Arendale, May 22, 2002.)
“Despite the state’s budget deficit situation this program is set to begin April 1, 2003.” (Letter from Vivian Huang, CPCA Policy Analyst, to Elizabeth Arendale, May 22, 2002.)
For more information on the California model please contact Vivian Huang, MHS, CPCA Policy Analyst at vhuang@cpca.org or via phone at (916) 440-8170, extension 238.
TEXAS:
The Texas model, called the Migrant Care Network (MCN), is focused on establishing Medicaid portability for Texas migrants traveling to selected pilot states. Targeted states include: Texas, Minnesota, Wisconsin, Indiana, Illinois, Washington, Florida, California, Colorado, and Ohio. Although a new approach with the farmworker population, it is not a new model. The MCN is a managed care model that has effectively been used with other populations (i.e. Medicare program for the elderly).
Status of the Texas Migrant Care Network:
- Texas House Bill 1537, was passed and signed by the Governor of Texas, Rick Perry, on June 11, 2001. Under HB 1537 the Texas Health and Human Services Commission (HHSC), was charged to conduct and report its “finding and recommendations regarding the establishment of a migrant care network” for children of migrant and seasonal farmworkers (MSFWs) enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
- The draft report was completed during the second quarter of FY 2002. Based on the findings, HHSC has recommended that a pilot be implemented.
- The Texas HHSC and TACHC are currently working on the model design, conducting focus groups with providers, and identifying potential partners in targeted to states to establish provider networks.
- Conducting legal analysis (i.e., necessity for waiver or Medicaid plan amendment)
- State issued RFPs for contractors to establish and manage a provider network due to the State on January 27, 2003.
For more information on the Texas Migrant Care Network Model please contact Jana Blasi, TACHC Deputy Director, at jblasi@tachc.org or via phone at (512) 329-5959.
MICHIGAN:
In late 2000, The Michigan Primary Care Association formed a coalition to establish a plan of action for improving the health of migrant and seasonal farmworkers. The plan identified six priority focus areas for the state. Goal B of The Plan of Action for Improving the Health of Migrant and Seasonal Farmworkers [in Michigan] is to increase access to publicly funded health insurance programs. Objectives identified within Goal B of the Michigan Action Plan are:
- Encourage Michigan Providers to participate in the Texas Migrant Care Network (MCN) pilot.
- Advocate for presumptive eligibility of migrant farmworkers in Medicaid, MIChild and MIFamily programs.
- Promote migrant farmworker enrollment in Medicaid, MIChild, and MIFamily.
- Advocate for modifying existing Medicaid policy to carve-out migrants from the managed care program.
Status of Goal B of the Michigan Migrant Health Plan:
- The Plan of Action for Improving the Health of Migrant and Seasonal Farmworkers was published by MPCA on October 9, 2002.
- The Michigan Primary Care Association, and Migrant Health Coalition are poised to collaborate with the Texas on the implementation of the Migrant Care Network Pilot.
- MPCA has begun discussions with the state Medicaid office regarding carving migrants out of managed care.
- Presumptive eligibility efforts have been scheduled to start in November of 2002.
For more information on The Plan of Action for Improving the Health of Migrant and Seasonal Farmworkers please contact Carol Parker Lee, MPH, MPCA Chief of Policy & Planning at cplee@mpca.net or via phone at (517) 458-8000, ext. 205.