Officials explain changing migrant health programs

 By Editor Ken Harvey

Washington State offers low-income and undocumented migrant students better health coverage than any other state in the country, says Migrant Health State Supervisor Mike Taylor.

 “Nothing else is even close,” says Taylor, who meets with other U.S. migrant health officials on a regular basis as part of a federal committee trying to improve health care for migrant students nationwide.

“Washington State is by far the best. So you want kids who move into your districts to get taken care of,” he says.

 He is often asked why Washington State offers so many services to undocumented kids.

 “First, it’s the moral thing to do,” Taylor says. “But, second, it makes fiscal sense, as well.  Approximately 90 percent of them will end up U.S. citizens anyway, and it will cost more later if they have the same health problems as their parents.”

 Taylor says good health is also critical to children’s success in school. If they have tooth aches and other ailments, they won’t be able to concentrate in the classroom.

 “You want to work really hard with these kids so they are healthy and they can get through the K-12 system,” he says.

 Washington’s health care system has not always been as open as it is now. But it has been expanded significantly since Gov. Christine Gregoire took office.

 “Luckily for us in Washington, Gov. Gregoire has expanded coverage to include all children, regardless of their legal status,” says Alma Rojas, financial services supervisor for the Region 2 Community Service Center of the Department of Social and Health Services (DSHS).

 Speaking at the recent annual conference of the Office of Migrant Student Data and Recruitment (MSDR), Rojas and Rocio C. Loera, the community relations coordinator for the DSHS Region 2 Division of Employment & Assistance Programs, explained that the state’s program covering low-income migrant youth is now called the Children’s Medical Program (CMP). The state-funded program is comparable to the federally funded medical coupon program, including vision and dental, they explain.

 “So all they have to do is find a provider who accepts medical coupons,” says Rocio.

 In 2003 the Legislature de-funded the Medicaid look-alike Children’s Health Program that had provided migrant children covered by the Basic Health program, says Taylor.

 “Basic Health is very unforgiving. You miss a payment, you get a warning. You miss a second payment and you are out for a year. Basic Health has a monthly deductible, and doesn’t cover optical or dental,” he adds.

 Not everyone could get into Basic Health right away, and some of the most serious health problems discovered during annual screenings at school, provided by the Migrant Education Program, are dental problems not covered under Basic Health.

 Taylor urges federal projects directors, migrant program record clerks and migrant home visitors to get migrant students transferred over to CMP.

“Many of the migrant kids are still sitting in Basic Health, and Basic Health is not going to transfer them back on to this program automatically. My assumption was that the state would move these kids into a better, more manageable program for the families. But what I want to say to you is if you have children on Basic Health who qualify for this program, get them transferred over,” Taylor says.

 “Now there is no waiting list like we had before. It’s a great program,” Rojas adds.

 Taylor says once children are on the program, their income is not reviewable for 12 months. So the best time to get them into the program is when their income is really low – less than 200 percent of the federal poverty level.

 “Even if they do go over 200 percent the next month, that’s still not enough to live on,” he adds.

 “We guarantee them coverage for 12 months, no matter how much money they make in the middle of that certification period,” Rojas says.

 She explains if a family is over 200 percent of federal poverty level but under 250 percent, it can still apply and qualify for low-premium coverage of $15 per child per month, with a maximum of $45 per month for all children in the family up to age 19.

 And if a family qualifies at 250 percent for the low premium but its income drops under 200 percent later, it can reapply and have the premium eliminated, she says.

 The family can also choose to stay on Basic Health to cover the whole family, in which case the CMP medical coupons will cover whatever Basic Health does not -- including optical and dental, says Rojas.

 Parents can go to a DSHS Community Service Office to get help filling out the required paperwork, or there are also DSHS employees stationed at major health clinics, such as the Yakima Neighborhood Health in Yakima and Sunnyside; Yakima Valley Farm Workers Clinic in Yakima, Grandview and Toppenish; Memorial Hospital in Yakima; and at La Clinica in Pasco.

 “If all they need is medical coverage, then they don’t have to come to DSHS. They can go directly to a clinic and get assistance filling out the application,” says Rojas.

 Migrant home visitors and other advocates working with local school districts can also call the DSHS toll-free number at 877-KIDS-NOW and request copies of the application if they want to help students’ parents fill them out, she says.

HOW THE SYSTEM WORKS

 Once accepted into CMP, the process is fairly simple but important to understand, say the DSHS representatives.

 “They will be given an ‘open coupon’ for the first two months so they can take that coupon to any provider they choose, and then they must choose a Healthy Option Plan with a particular provider,” says Rojas.  “There are many different providers, and they can go to any one that accepts coupons during the first two months.”

 They can let a clinic know they have the coupon and get the paperwork completed without anyone actually needing medical services at that time.

 “After two months, if they fail to choose a plan, then they will automatically be assigned one. So it’s important that when they get the coupon information in the mail that they choose the one they want,” says Rojas.  It is possible to transfer to another provider, but it takes about 30 days.

 If a family migrates to another part of the state for a short period of time to harvest a particular crop, they do not have to transfer to a different clinic. If a child gets sick, the family can go to a hospital emergency room and still get coverage under the plan, Rocio explains. The ER does have to agree that it is an emergency.

 Besides Children’s Medical, DSHS provides a number of health-related programs, including:

• Pregnancy Medical, for pregnant women regardless of legal status.
• Family Medical for families in poverty.
• Disability Medical Program for disabled adults.
• Medicare Savings Program to help those on Medicare pay premiums.

 Undocumented residents do not qualify for all of these programs, but “if undocumented adults with children under 18 have medical needs, we can get them covered under Family Medical,” Rojas says. “But we’re concentrating on children, especially for medical.”

PHARMACEUTICAL PROGRAMS

 Another new program provides discount pharmaceutical cards free to all Washington residents. With the card, generic drugs are discounted up to 60 percent and name brands 20 percent, Rocio says. Washington residents can sign up by phone or on the Internet at www.rx.wa.gov, or they can pick up a form from DSHS. The form, she says, is very simple and non-intrusive.

 “They say they will give you a discount even on your co-pay” if a resident is already covered by insurance, depending on the medication. All members of the family need their own card, Rocio explains.

 She also notes the “$4 prescription program” now offered by Wal-Mart. Prescriptions start at $4 and go up from there, but the pharmacy will tell the client what the cost will be before filling it. People can call 1-800-WAL-MART for more information.

DSHS ALSO PROVIDES CHILD CARE

 DSHS also provides funds to help pay for child care costs for low-income workers.

 “A lot of parents are taking their children out into the orchards, and that’s not safe for them,” says Rojas. “You just call our toll-free number (877-980-9140), and we can help you with the costs.”

 “Child care can be pretty expensive,” Rojas says. The program allows payment to go to an eligible relative caring for the children or to a licensed day care provider. The provider must be 18 years of age or over, eligible to work in United State, and pass a criminal background check.

 Many other services are also available through DSHS, including programs for such things as substance abuse and food assistance. “But the majority of our programs are centered around children and disabled adults,” says Rocio.  For more information, go to  www1.dshs.wa.gov.

 Taylor builds partnerships with public and private agencies.

 “We’ve worked really closely with the Department of Social and Health Services to define all the programs they offer because they are the first payer of resort when it comes to children’s health, such as Children’s Medical,” says Taylor.

 He cannot pay for services out of the federal Title I Migrant funds unless state and local funds are unavailable, and the services are included in his Migrant Education Health Program grant, he explains.

 “Whatever they can’t cover for the kids, it comes to us and we take care of it,” Taylor says. “They are specifically charged with providing those services, and that’s why we partner with them and with non-profit clinics to find a solution. We’re going to do our best to get coverage for kids.”

 The Migrant Health state supervisor encourages local migrant education officials to call for help when they need it.

 “These are your step-up-to-the-plate folks,” he says, referring to Rocio and Rojas. “If you have a question or a problem with the system, you call them. They may know the answer, but if they don’t, they’ll trouble-shoot it for you. Don’t waste your time trying to grope around in the dark. It’s too confusing, and it changes daily, almost. These people know what’s what. You have better things to do that you’re experts at.

 “If you have major problems, you can also call me, and I’ll help,” Taylor says.