National
Advisory Council on Migrant Health (NACMH) Recommendations,
2005
Secretary Michael Leavitt
Department of Health and Human Services
Washington, D.C. 20201
Honorable Secretary Leavitt:
On behalf of the National Advisory Council on Migrant Health (Council), we would like to take this opportunity to welcome you. Thirty years ago, Congress created the Council to advise the Secretary of Health and Human Services on matters concerning migrant health. The following paragraphs of this letter set forth the recommendations of the Council to you compiled during Fiscal Year 2005.
A. Develop a mechanism to ensure States comply with 45 CFR 233.40, which would allow a migrant farmworker who is temporarily working out of State to be eligible for Medicaid in the State in which he/she is working.
We believe that overcoming this barrier will increase the opportunities migrant and seasonal farmworkers have in accessing health care. This was one of the recommendations made last year by the Council to Former Secretary Tommy Thompson (please refer to the attached letter sent to Former Secretary Tommy Thompson dated May 21, 2004 for further details). We believe that this is a key point in the need to support Migrant Health Centers (MHCs) providing care. It would increase success of recruitment and adherence issues among this population. The Council recommends that the Secretary continue looking into this matter to expeditiously be resolved.
B. Develop a mechanism to ensure States comply with 42 CFR 435.904, which directs States to place in each Federally Qualified Health Center (FQHC) a State employee who is responsible for screening patients of the FQHC to determine whether the patients are eligible for Medicaid.
The Council believes that having a person in each health center screening patients for Medicaid eligibility will result in more farmworkers seeking medical assistance on a timely basis. Unfortunately, States are not consistently following this Federal regulation; therefore, the Council recommends that the Secretary develop a mechanism to ensure the implementation of this regulation nationwide.
C. Assure the immediate release of the Farmworker Access Study to Congress.
In 2002, Congress passed the Health Care Safety Net Amendments Act. Section 404 of PL 107-251 directed the Secretary of Health and Human Services to deliver to Congress a written report containing recommendations for removing barriers to health care that are currently being experienced by farmworkers. The delivery of this report to Congress was due on October 2003. We understand that clearance is almost complete on its release. Placing this report on the hands of Congress is an important step on the road to improving farmworkers’ access to health care and assuring better service delivery by MHCs.
D. Increase the grant-dollar, per user allocation differential for farmworkers.
According to guidelines for funding for the Presidential Initiative, FQHCs providing services to migrant and seasonal farmworkers were allowed to spend up to $200 per farmworker user. The rational behind this differential was that it is more costly for health centers to serve farmworkers than to serve non-farmworkers. Several factors contribute to health centers incurring more expenses in serving farmworkers than in serving non-farmworkers, for example, a high percentage of uninsured in the farmworker population, the poorer quality of health that is generally found in the farmworker population and the necessity of providing ancillary services to farmworkers such as outreach, transportation, translation services, etc. The Council recommends that this differential be increased according to the increase in the rate of inflation in the past several years.
E. Maintain the present formula set forth for allocating funding to migrant health as set forth in section 330 of the Health Care Safety Net Amendment Act of 2002.
The Health Care Safety Net Amendment Act of 2002 recommended that 8.6% of the funding described in Section 330 is to be used exclusively to fund migrant health. This has ensured that the population putting the food on the table of our families obtains basic health care through MHCs and other supported programs. The Council believes this formula is vital to the assurance of health care to migrant workers and strongly recommends that the Secretary ensures this is maintained.
Our goal is to assist you in the prospect of improving access to health care by migrant and seasonal farmworkers. We believe that as our new leader, a dialogue between us would enhance the mutual understanding of the matters raised in these recommendations. During FY06, the Council will be celebrating
its 30th Anniversary and plan to be meeting at least once in the Washington, D.C. area. We will be very honored if you are able to join us.
On behalf of the Council we would like to thank you for your time and consideration.
Sincerely,
/s
Guillermo Martinez
Chair, National Advisory Council on
Migrant Health
/s
Karen Watt
Vice-Chair, National Advisory
Council on Migrant Health
cc: Dr. Elizabeth M. Duke
Ms. Michelle Snyder
Dr. Marcia Gomez
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