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National
Advisory Council on Migrant Health (NACMH) Recommendations
- 2007
The Honorable Secretary Michael O. Leavitt
Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Secretary Leavitt:
The National Advisory Council on Migrant Health
(Council) offers you a new set of recommendations
predicated upon recent testimony held in Florida,
October 18th, 2007, and a site visit to a Michigan
farm during the Council’s meeting this
past July. We believe that if these recommendations
are acted upon in a timely and aggressive manner,
your action will yield significant positive
results for the Migrant Health Center Program
and the migrant and seasonal farmworkers (MSFW)
we serve.
During the October meeting, a diverse group
of stakeholders: farmworkers, clinicians, health
promoters and administrators provided testimony
that has shaped our recommendations. The most
current issues impacting the provision of health
care for farmworkers (for example, the dire
need for specialty care services, the severe
primary care health manpower shortage and the
lack of appropriate funding for Migrant Health
Programs (MHPs) impairing the ability to provide
a full scope of health services including essential
enabling services) were presented.
As we mentioned in our last letter, the Council’s
Charter specifies our role as to advise the
Secretary on the administration of the Health
Resources and Services Administration’s
(HRSA) Migrant Health Center Program regarding
“health center funding mechanisms.”
We want to thank you for your responsiveness
to some of these issues. Mr. Steve Smith, Special
Advisor to the Administrator, HRSA; Mr. James
Macrae, Associate Administrator for Primary
Health Care, and Dr. Donald Weaver, Deputy Associate
Administrator, attended our meetings to listen
to and discuss our concerns. We applaud this
action and hope for this continued responsiveness.
The following are the new recommendations from
the Council:
Convening a Workgroup
In order to further augment input from grantees
and experts in the field we recommend that the
Secretary convene a workgroup representing grants
administration, Central Office Grantees and
MHP leadership to develop and adapt grant guidance
and funding criteria to reflect the special
needs and limitations of the farmworker population.
Funding Issues
In order to ensure that grant applications
address the needs of the migrant population,
a migrant-specific needs assessment data worksheet
should be developed and used to evaluate the
applications.
- Applicants should be required to present
delivery system models reflecting the unique
needs of MSFWs (Models that Work) in order
to be funded.
- Specific funding should be set aside for
enabling services.
- Augment the creation of new health centers
by providing planning grants and other infrastructure
development grants that are scaled to the
size of the population to be reached.
- A Policy Information Notice (PIN) Voucher
revision would be essential to spread the
success of such a methodology and help MHPs
utilize unique opportunities for serving MSFWs.
Grantees input will help to fund more MHPs.
Next Steps for CMS Farmworkers Portability
Study
Establish an interagency task force between
CMS and HRSA to formulate an action plan for
implementation of the HHS Farmworker Study,
including representatives of the MHP. Direct
this task force to explore demonstration projects
that will enhance access and help in the full
implementation of the Farmworker Study.
Training and Technical Assistance (TA)
Expand technical assistance for MHPs in Midwestern
States to provide the same migrant health coordinator
support that has been provided to regions on
the East and West coasts or increase financial
resources to Primary Care Associations (PCAs)
in selected Midwestern States (high impact migrant
states) to cover TA support in lieu of migrant
coordinators.
Partnership with States
- Support expansion proposals by States that
would increase coverage opportunities to the
number of uninsured MSFW families’ coverage
with SCHIP.
- Enforce Federal Law that mandates out-stationed
Medicaid eligibility workers in Migrant Health
Centers (MHCs).
Deficit Reduction Act (DRA) Impact
Under the Deficit Reduction Act, remove unnecessary
eligibility requirements, like birth certificates,
that act as barriers to families applying for
public benefits, in particular necessary health
benefits.
Specialty Care
Recognize the dire need for specialty care
(e.g., cardiology, podiatry, ophthalmology/optometry,
orthopedics, dermatology, nephrology, pediatric
dentistry and oral surgery, and other services)
to support primary care services for MSFWs.
Assure that specialty care currently provided
by MHPs be grandfathered into their scope of
services so that essential continuity of care
and access to care is maintained.
Health Information Technology
Promote Health Information Technology that
meets the health information exchange needs
due to the migratory nature of farmworkers and
assures the interstate transferring of critical
medical record information in accordance with
the highest standard of confidentiality.
Health Manpower and Workforce Development
- The National Health Service Corps (NHSC)
is essential in providing physicians, nurses,
dentists, and hygienists to serve migrants
in 330 funded programs. The Council recommends
the continued expansion of the NHSC to keep
pace with the expansion of Health Center Program
in response to Presidential Initiatives. The
Council realizes that the expansion of the
NHSC requires increased funding, which is
a function of the Congress. However, the Council
feels that strong support from the Secretary
and HRSA’s Administrator would enhance
the likelihood of the NHSC expansion.
- In the realm of workforce development,
the Council recommends that the Secretary
provide incentives for health professions
training programs to promote primary care,
including, as examples, family medicine, general
dentistry, and behavioral health.
- The Council recommends improving the Health
Professional Shortage Area (HPSA) scoring
mechanism or developing another methodology
that ensures that NHSC manpower is provided
to serve special populations, including MSFWs
and their families.
We look forward to meeting with you during
our Washington, DC Council meeting in February
2008, as requested in our letter dated September
20, 2007. We respectfully request this meeting
in person to be able to present the great needs
of migrant agricultural workers and the Migrant
Health Programs that serve them.
Sincerely,
/s/
Karen Watt Chair, National Advisory
Council on Migrant Health
|
/s/
John McFarland, D.D.S.
Vice Chair, National Advisory
Council on Migrant Health |
cc: Dr. Elizabeth M. Duke
Mr. James Macrae
Dr. Marcia Gomez
_______________________________________
1The National Advisory Council on Migrant Health
was statutorily created by Congress more than
30 years ago for the sole purpose of advising
the Secretary of Health and Human Services on
health matters affecting migrant and seasonal
farmworkers. Members of this 15-person Council
are appointed by the Secretary for four-year
terms. Presently on the Council are patients
of migrant health clinics, board members of
migrant health clinics, and employees of migrant
health clinics.
The Honorable Secretary Michael O. Leavitt
Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Secretary Leavitt:
Your National Advisory Council on Migrant Health[1]
(the Council) met in February in Rockville,
MD, to continue its work in advising you on
migrant and seasonal farmworker (MSFW) health
issues. We were most appreciative to have a
face-to-face meeting with Mr. Steve Smith, Special
Advisor to the Administrator, Health Resources
and Services Administration (HRSA); Mr. James
Macrae, Associate Administrator for Primary
Health Care, HRSA’s Bureau of Primary
Health Care (BPHC); and Dr. Donald Weaver, Deputy
Associate Administrator, BPHC. As a result of
our meeting, we now bring our recommendations
to you.
Behavioral Health
A. Since previous recommendations to address
substance abuse and mental health issues of
MSFWs and their families have not been successful,
the Council recommends that the Secretary facilitate
communication between the Substance Abuse and
Mental Health Services Administration (SAMHSA)
and HRSA (specifically, the Migrant Health program
within the BPHC) to develop, initiate, and expand
behavioral health services to MSFWs and their
families.
B. In light of the shortage of behavioral health
specialists in migrant health/community health
programs, the Council recommends a review of
best practices and/or a demonstration project
to provide training to primary care providers
in migrant health programs around behavioral
health. Since training would be provided by
specialists in behavioral health (i.e., psychiatrists,
psychologists). The objective of this training
would be to allow primary care providers to
recognize and treat common mental health and
substance abuse conditions in the MSFW population.
Access
C. During the past year, we heard many concerns
expressed by representatives and partners of
Migrant Health Programs. These concerns were
centered on how there has historically been
challenges in meeting and/or maintaining the
legislative requirement of 8.6% of the total
Health Center Budget allocated to the Migrant
Health Program. Therefore, taking these concerns
into consideration and in order to realign the
Migrant Health Program grant making and grants
administration with the provisions of the authorizing
Migrant Health 330(g) legislation, we would
like to make the following recommendations.
- Traditionally, there have been challenges
with the Policy Information Notices (PINs)
issued by HRSA incorporating the specific
needs of the Migrant Health Program and the
MSFWs. These challenges have been experienced
in New Access Points, Expanded Medical Capacity
and Service Expansion grant announcements.
We recommend that HRSA develop PINs which
are specific to the Migrant Health Program
for these funding opportunities, and are specifically
tailored to address the unique requirements,
as provided for in the 330(g) legislation,
of delivering health services to the MSFW
population. The Migrant Health PINs should
increase the availability and utilization
of funds for this population; therefore, the
PINs should:
- Provide an inclusive mechanism of comprehensive
health center clinical services, including
medical, dental, and behavioral health
services.
- Require and fund essential and enabling
services, such as outreach, transportation,
translation, enrollment, and case management
services, in order to meet the unique
needs of the MSFW population.
- Provide funding of new or expanded
service delivery methods designed to reach
a mobile, dispersed, hard-to-reach population,
emphasizing voucher programs, small, part-time
or seasonal outreach satellites, and mobile
services.
- Concerns were also expressed about the
grant review process as to the ability and
knowledge of the objective review committee
members to accurately provide viable recommendations
that are realistic to the Migrant Health Programs.
Therefore, we recommend that HRSA ensure that
grant reviewers of migrant health grant applications
have field experience with services to MSFW
populations.
- It has also been a concern that programs
receiving funding to provide services to the
MSFW population are not maximizing their efforts
in providing care to this population. We strongly
recommend establishing grant performance measures
that hold migrant health grantees accountable
for the provision of comprehensive primary
health servicesand enabling services, such
as outreach, transportation, translation,
and enrollment services.
We believe that the best outcomes could be
achieved if your office convenes a workgroup
composed of both HRSA staff and people experienced
with health service delivery to MSFW and charges
the workgroup to provide recommendations to
the above objectives.
Policy
D. The President’s Initiative focusing
on the poorest counties in the U.S. does not
take into consideration the poorest population
of migrant farmworkers who are often not in
the U.S. Census because they are mobile, traveling
from State to State. In the President’s
High Poverty County Initiative there is a strict
geographical-based definition that qualifies
the county for eligibility and does not allow
for the count of the medically underserved population
(MUP) of migrant farmworkers to be considered
in the designation of a “poor county.”
We recommend that the High Poverty County Initiative
provide funding to applicants that propose to
provide services to poor populations that demonstrate
significant unmet need and who can show that
there is an MUP of migrant farmworkers living
in a county or other geographic area.
E. The release of the CMS Farmworker Study
confirms the Council’s previous 2005 recommendations
which found that States have failed to comply
with existing Federal regulations. Two such
regulations include the definition of a resident
for the purposes of receiving public benefits
and the requirement that States under 1902 (a)(55)
of the Social Security Act place out-stationed
eligibility workers in Federally Qualified Health
Centers. The Secretary should enforce these
regulations as substantiated in your 2006 report
to Congress.
On behalf of the National Advisory Council
on Migrant Health, we would like to thank you
for your consideration of these recommendations.
Sincerely,
/s/
Karen Watt Chair, National Advisory
Council on Migrant Health
|
/s/
John McFarland, D.D.S.
Vice Chair, National Advisory
Council on Migrant Health |
cc: Dr. Elizabeth M. Duke
Mr. James Macrae
Dr. Marcia Gomez
_______________________________________
[1]The National Advisory Council for Migrant
Health was statutorily created by Congress more
than 30 years ago for the sole purpose of advising
the Secretary of Health and Human Services on
health matters affecting migrant and seasonal
farmworkers. Members of this 15-person Council
are appointed by the Secretary for four-year
terms. Presently on the Council are patients
of migrant health clinics, board members of
migrant health clinics, and employees of migrant
health clinics.
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