National Advisory Council on Migrant Health (NACMH) Recommendations, 2006 (first 2006 letter)

• printer-friendly letter (Acrobat/pdf)

March 27, 2006

Secretary Michael Leavitt
Department of Health and Human Services
Washington, D.C. 20201

Honorable Secretary Leavitt:

The National Advisory Council on Migrant Health (Council) hereby transmits to you the Council's recommendations for improving health care for migrant and seasonal farmworkers:

A. Support the reauthorization of the Health Center Consolidation Act, including those portions of this Act pertaining to the retention of community-based boards of directors, maintaining proportional funding for farmworker health, and the present definition of migrant and seasonal farmworkers.

Although there are some aspects of the Health Center Act that could be improved, the present legislation has served the country sufficiently well such that no significant changes are necessary.

B. Continue the present level of training and technical assistance provided by Central Office Grantees (COGs).

The Council believes that given the health center delivery system that has evolved to meet the needs of migrant farmworkers, the COGs provide an indispensable support system for the nation's farmworker health centers. The rural and migratory nature of migrant farmworkers requires the assistance provided by these COGs. In addition, the present Request for Proposal's (RFP) process has presented barriers for migrant health applications, which the COGs have helped overcome, and therefore we strongly recommend that the Secretary retain the support provided by the COGs.

C. Accelerate the review by all governmental entities, including the Department of Health and Human Services, of the Farmworker Access Study mandated by the Health Care Safety Net Amendments of 2002. In order to expedite the provision of needed health services to farmworkers, pending this review the Secretary should designate all federally qualified health centers' (FQHC) as out of state providers.

In the Health Care Safety Net Amendments of 2002, Congress required the Department of Health and Human Services to conduct a study analyzing the barriers to health care confronted by farmworkers. This Amendment required this study to be submitted to Congress by April 1, 2004. Every day, eligible farmworkers confront obstacles to obtaining health care. The report to Congress is just the first step in eliminating these barriers.

One administrative barrier, most apparent after Hurricane Katrina, is the difficulty that a FQHC in a state where services are rendered has in billing for services provided to patients who are residing only temporarily in the providing state. The FQHC providing the care to a farmworker from another state often is unable to bill the farmworker's home state in a reasonable and timely manner, given the present administrative process for determining and approving out of state providers and for approving
out-of-state claims.

Migrant farmworkers are not eligible for the providing state's Medicaid program until they are enrolled in that program. The administrative burden of this enrollment process is frequently not justified by the money received for a one-time, minor procedure. If all FQHCs were designated “out of state providers” by the Secretary, then the providing migrant health center could simply bill the Medicaid agency located in the home state of the migrant farmworker and this administrative obstacle would vanish.

D. The Department of Health and Human Services should increase the number of in-house, oral health programs in migrant health centers to 75%.

There is a documented high incidence of dental disease among migrant and seasonal farmworkers and their families. Migrant populations have three times the incidence of dental decay than the average population. Among migrant children ages 10-14, dental disease is the most common health problem, and among migrant children ages 15-19, dental disease is the second most common health problem. Increasing the number of in-house, oral health programs in migrant health centers to 75% is necessary in order to combat this widespread health problem.

On behalf of the National Advisory Council on Migrant Health, we would like to thank you in advance for your consideration of these recommendations.

Sincerely,

cc: Dr. Elizabeth M. Duke
Ms. Michelle Snyder
Dr. Marcia Gomez