Washington Migrant Health
Care Lauded, But
National System ‘Broke’

By Editor Ken Harvey

Migrant educators and administrators from throughout the U.S. lauded the work of Washington’s Migrant Health State Supervisor Mike Taylor and the health care provided migrant children in the state.

Washington’s system isn’t perfect, but it is a lot better than what’s available in most other states, Taylor says. It includes a Medicaid program with a higher income eligibility than most states and a state “Medicaid look-alike program” that provides health care to undocumented migrant children not covered by the federal program. Few other states have such a program.

In addition, Taylor works with health providers to plug gaps in coverage.

What migrant education programs can do to improve students’ access to health care was the topic of discussion in a workshop at the National Migrant Education Conference.

Other top migrant health officials participating in the workshop included Mary Anne Hay, Northeast Arkansas Migrant Education Cooperative; Mary Ellen Good, director of federal programs, Centennial BOCES, Greeley, Colo.; Terry Delgado, consultant with California’s Migrant, Indian and International Education Office; and Philip Kellerman, president of the Harvest of Hope Foundation, based in Gainesville, Fla.

The five migrant officials are part of the Migrant Education National Health Work Group assembled by former Director Francisco Garcia of the Office of Migrant Education to develop national health standards for migrant education.

And all of the panelists lauded Taylor’s work in Washington.

“We have a model program in Washington and very little in other states,” says Kellerman.

“When we met the other day, one of the solutions offered was that all the migrant families move to Washington because they have wonderful services,” Good says jokingly. “We’ll just send everyone to Mike.”

But, more realistically, migrant health officials need to work little by little to build relationships and service networks like Taylor has done.

“I advocate for kids,” Taylor told workshop participants. Besides hooking them up with the state health system, he creates partnerships with doctors, dentists and non-profit clinics.

One of the most serious health issues for migrant children is dental care. By partnering, Taylor has been able to turn $40,000 in his budget into $260,000 in services.

Contrary to what some might suppose, “providers welcome educators’ efforts to facilitate services,” Taylor explained.

Among the partnering providers in Washington and around the country are the Community/Migrant Health Centers funded under the Consolidated Health Care Act and overseen by the U.S. Department of Health and Human Services. Altogether there are 129 centers and 629 satellite service sites. A list of those centers and satellites can be found at http://ask.hrsa.gov/pc/.

Despite these centers, “our health care system is broken,” says Good, noting that the Community/Migrant Health Centers only serve about 15 percent of the migrant families nationwide. “There are not enough of them.”

“Our nation spends more money on health care than any other country but we get less for it,” says Taylor.

Delgado works with 23 different regions in California to make sure migrant students have access to health and dental care.

“A healthy child is a child ready to learn,” she says.

“If a child is tormented by the pain of a tooth ache, how well can he learn?” asks Good. If he needs glasses and sits in the back of the room, can he learn? If his ears are plugged and he’s already struggling to listen to what to him is a foreign language, will he understand?

“What do you do? You space out, and you probably become a discipline problem,” says Good. “It all comes down to education. It’s obvious to most of us that health affects learning. We’re out to prove that. We shouldn’t have to prove it. It should be an obvious truth.”

One child recently died because of a simple, untreated tooth infection that spread and turned in spinal meningitis, Good recounted. On the other hand, many migrant students may be “over-immunized” because their health records are not shared.

The leaders said among the most ignored health problems are:

• Dental health, the No. 1 problem.
• Mental health – “the unspoken problem.”
• Chronic health problems – diabetes, cholesterol, obesity, etc., even among 13- and 14-year-olds.

Like Taylor, Hay develops free health screenings for migrant students.

“I work on the ground level with migrant families,” she says.

Good also tries to negotiate with clinics and other health providers to stretch migrant health funds.

“Most health providers really do care and say, ‘Thank you for helping,’” she says.

To facilitate partnerships with individual clinics, Taylor says it’s necessary to develop personal relationships with providers.

“You have to have a good relationship with each clinic. I have a key person I deal with in each clinic. I’ve got them to understand that the highest-risk kids are the migrant kids,” says Taylor.

The Washington supervisor says when he first took over the program, he conducted his own needs assessment to understand the nature of the problems facing migrant children. He also began attending conferences around the state to see which were the “step-up-to-the-plate” health providers with whom he might partner.

Migrant health providers often face chaotic, almost overwhelming conditions in trying to serve so many needy families, Taylor notes. “If you can help with registration and with translation, you’re going to go to the front of the line. They are inundated with too many people, so if you are going to help them with the process, they’ll work with you.”

Good says it helps a lot to offer to join the board of directors of key non-profit clinics – or find others involved with migrant families to do so.

“When I walk into the room they say, ‘Here she is. We have to talk about migrant kids today,’” Good says.

Community/Migrant Health Centers are required to have users and clients represented on their boards.

“If you can get on their board, you can help determine where the money goes and not let them forget about the kids who are underserved,” Good says. “Get inside their world and understand their language. And if not you, who? There has to be someone who can serve on those boards or advisory groups.”

“That’s a good point,” agreed Taylor. “And find out who is already on the board. It helps if you let the clinics know that you are friends with someone on the board, and that’s all that needs to be said. You’ll be surprised who’s on the board sometimes.”

With other groups, it just takes time and communication. Taylor notes that when he first started working with Washington’s Smilemobile, sponsored by the Washington Dental Association, officials were a little hesitant. But over time they have come to understand that migrant children are the children with the greatest needs.

Now Taylor and the Smilemobile work together extensively, especially in rural communities that lack much dental service.

“And when I get a bill for $500, it’s for services that would have normally cost about $5,000,” Taylor says.

Kellerman’s non-profit foundation provides assistance nationwide. The foundation’s mission includes providing migrant farmworker families with emergency aid and coordinating with government and non-profit agencies to assist migrant families with medical needs.

Kellerman recognizes that for migrant health officials outside of Washington, many of them are on their own and are scrounging for any help they can get. Frequently they call his hotline.

“When I get health calls, the first agency I call is the National Center for Farmworker Health [NCFH],” Kellerman says. “They are a very valuable resource. They have funds to help with medical services. They have some restrictions, but they provide assistance whether they are documented or not documented.”

The NCFH’s direct toll-free phone is 1-800-377-9968.

“If you have a family that needs medical assistance, you should contact them first,” Kellerman recommends. They provide up to $600, but “they are very, very good at negotiating with doctors and getting better rates. They’re always trying to negotiate the best deal possible.”

Once people try the NCFH, then he invites them to call his own organization at 1-888-922-4673.

He recommends negotiating with local health providers first, but even then his foundation may be of service.  On behalf of his non-profit foundation, he can write letters documenting doctors’ donation of services so they can get a tax deduction.

While Washington has the best migrant health care, Georgia has the worst, Kellerman says. He has had to arrange for an undocumented child with leukemia to be treated in a neighboring state. And an adult farmworker with kidney problems was told he would not be able to get further help until he goes into renal failure.

The problems facing migrant health officials do not always relate to money, says Taylor. Just as often it is lack of human resources. That’s, again, why he works to develop a network of partnering agencies to assist.

The Community/Migrant Health Centers, he says, are the most important, but migrants don’t always live close to one, and high gas prices and long work hours discourage much travel.

Good recommends working with service clubs, such as Rotary or Kiwanis, to build community support, along with individual dentists and doctors. College dental training programs can help provide screenings, with the help of local professionals.

Once you get a provider involved, it’s not that hard to keep them involved, she says.

“You can’t help but fall in love with migrant children,” Good says. “All the providers need is a little exposure to these children.”

The workshop presenters provided attendees with a handout suggesting the roles and responsibilities of health coordinators.

• As an ADVOCATE he voices the needs and rallies support for migrant families, participating on committees, conducting needs assessments, etc. He identifies strategies for developing a network of support and validates the support of local providers with appropriate recognition.
• As a COORDINATOR he coordinates regional health activities with school districts and community agencies.
• As a TEACHER he provides health information, secures the services of other experts and identifies strategies for teaching families how to navigate the health care system.
• As a PARTNER he establishes and participates in school-community partnering activities related to health and social services for migrant families. These include collaborations with local agencies and formal programs, such as First 5 Healthy Kids and Dental Health Initiatives.
• As a RESOURCE he keeps abreast of trends and issues in health care; learns about all available health, social and educational resources available to him; informs families of available resources, possibly including the development of service directories and fact sheets; and disseminates information to educators throughout the area relating to health resources and health education.

Taylor warned those attending the workshop not to expect to develop a network like Washington’s overnight.

“You need to keep your vision small at first and then expand it out,” he says.