NATIONAL ADVISORY COUNCIL ON MIGRANT HEALTH (NACMH)
Conference Call - November 15, 1:00 p.m. - 4:00 p.m.
Meeting Participants:
Council Members
Wenceslao Vasquez (Chair), Robert Scott (Vice Chair), Rosita Castillo, Susana Castro, Enedelia Cisneros, Edward Colon, Anne Kauffman Nolon, Guillermo Martinez, Robert Nimmo, Diana Sanchez, Gilbert Walter, Karen Watt.
Council Members Not Present: Rogelio Fernandez, John McFarland
Federal Staff:
Marcia Gomez, M.D., Designated Federal Official (DFO); William Johnson, Office of Minority and Special Nominations (OMSP); Gladys Cate, NACMH Staff Support.
Members of the Public
Roberta Ryder, National Center for Farmworker Health; John Ruiz, National Association of Community Health Centers (NACHC)
CALL TO ORDER AND WELCOMING REMARKS
The Chair called the meeting to order, welcomed the meeting participants, and asked if there were any changes in the agenda. Gilbert Walter proposed to add a discussion on the rough draft letter, prepared by Anne Nolon, to the Secretary requesting for a face-to-face meeting at the next NACMH's meeting in February 5-6, 2006. Guillermo Martinez moved the motion to approve the Agenda, Dr. Colon seconded. The Agenda was approved.
Referring to the minutes of May 21-22, 2006, the Chair asked if there were any changes before the approval of these minutes. Anne Nolon made the motion to approve the minutes, Enedelia Cisneros seconded. The minutes were approved.
BUREAU OF PRIMARY HEALTH CARE (BPHC)/OFFICE OF MINORITY AND SPECIAL POPULATIONS (OMSP) UPDATE
- Marcia Gomez, M.D., Senior Advisor on Migrant Health, NACMH Designated Federal Official, OMSP
Dr. Gomez started her update by letting the NACMH members know that the Uniform Data System's update for 2005 was completed. There was an increase in the number of migrant and seasonal farmworkers (MSFWs) and their families served at the Migrant Health Programs (MHP). This increase is significant if compared to the MSFWs served in 2004: 42% patients between the ages of 0-19 (usually children eligible for insurance), and 56% patients between the ages of 20-64 (mostly male and uninsured).
During FY 2005, two Expended Medical Capacity funding opportunities were approved. One of them was exclusively for special populations. 27 MHP were approved, and received the funds in FY 2006. During FY 2006, the President has proposed $181 Million increase for the entire health center budget; 8.6% goes to MHPs (about $15.5 Million). The announcement for New Access Points has been made and the applications are due December 6, 2006 - as part of the First Presidential Initiative (PI-1). Dr. Gomez noted that this is the fifth and last year that NAP will be available. If the budget is approved, it is expected to award about 102 NAPs applications. The Migrant Central Office Grantees (COGs) have been working very hard to identify those health centers interested in submitting in applications and to make sure that training and technical assistance is provided.
During FY 06 there were no funds approved for NAP. Since the initiation of the PI-1, the BPHC has received 60+ applications for MHPs; half of those were funded. HRSA hopes to receive a similar number of applications or more for this new NAP funding opportunity. There are six weeks left before the applications are due - December 6, 2006.
Another announcement will be made for a Second Presidential Initiative (PI 2), which will target high poverty counties - about 80 NAPs applications, and 50 additional planning grants.
Anne Nolon asked clarification on the definition of "poor counties". Dr. Gomez responded that at this time we do not have that information. Anne Nolon made emphasis on the fact that migrant farmworkers usually work in metropolitan areas, not in "poor counties". For migrant health this will not make sense at all. Dr. Gomez encouraged NACMH members to discuss this in future meetings.
Dr. Gomez asked the NACMH members to provide comments on the Service Area Overlap that will be coming out soon. In reference to emergency preparedness, the BPHC is working on the requirements and expectations from health centers. She asked the Council members to provide comments - from the perspective of special populations - on these guidelines when they become available.
Dr. Gomez informed the NACMH that the BPHC will be going through a re-alignment. A Federal Register Notice will be published soon.
Dr. Gomez encouraged NAMCH members, as experts on migrant health, to serve as reviewers on the Objective Review Committee (ORC) for NAP migrant health applications. At this time, she is not sure when the ORC panel will be put together. Robert Scott asked if these are compensated positions. Dr. Gomez responded that there is an honorarium fee (about $200/daily) plus travel expenses (hotel, airfare, ground transportation, meals). Their expertise is really necessary.
Anne Nolon expressed her concern about the requirements to qualify as a migrant reviewer. Specifically, the announcement that she received requested for reviewers who speak and write Spanish. This may diminish the possibility to recruit migrant health reviewers and might eliminate migrant health experts when they are desperately needed. Dr. Gomez responded that even though the applications are written in English, there might be some supporting documentation written in Spanish. As an example, the BPHC has received applications from Puerto Rico with supporting letters in Spanish. Also, BPHC is trying to be more cultural competent, and if the BPHC recruits reviewers who are experts in migrant health and they also speak and write in Spanish, those applicants who submitted information in Spanish, will not suffer any disadvantage.
Gilbert Walter added that it is the responsibility of the applicant to translate those documents into Spanish, because not everybody on the review panel will be able to review that information. He believes that there is a conflict on this. It is up to the integrity of the ethical system.
Dr. Gomez emphasized that HRSA is trying to be culturally-sensitive to those areas of the United States with Spanish population. Also, the reviewer may excuse himself/herself from those applications that he/she cannot review.
Update on Nominations/Appointments of New NACMH Members and Tenure of Current NACMH Members . In reference to the new NACMH appointments, the new six positions have not been approved yet. NACMH members are asked to serve up to120 additional days if no appointments are approved after November 25 th , 2006.
CMS Report. Dr. Gomez concluded her presentation by adding that the CMS report has not been published. It has not been officially sent to Congress, and is not officially public.
Robert Scott introduced the next point of the Agenda.
MIGRANT AND SEASONAL FARMWORKERS ENUMERATION PROFILES STUDY
• Bobbi Ryder, CEO, National Center for Farmworker Health (NCFH)
Bobbi Ryder thanked the NACMH for the opportunity to help with the arrangement of the meeting and testimonies during the last face-to-face meeting San Antonio , TX . She added that it was during the course of that meeting the NACMH members asked the question: "How we could get a better handle on where the need is in the community in terms of potential number of farmworkers in order to formulate recommendations to the Secretary regarding that need?" At that time, Bobbi indicated that there were two studies available on the NCFH's web site about that subject.
Today, Bobbi Ryder is responding to their request for information on those studies. She will be using the on-line presentation "Webinar". She emphasized the fact that this was not a substitute for a full face-to-face presentation and encouraged NAMCH members to contact her for more detailed information. The first study was commissioned by the BPHC through NCFH to work with Dr. Alice Larson from Washington to enumerate/estimate the number of migrant and seasonal farmworkers and their families that were present in 11 States: Arkansas , California , Florida , Louisiana , Maryland , Mississippi , North Carolina , Oklahoma , Oregon , Texas , and Washington . Subsequent to that, and through private contract, Dr. Alice Larson has conducted two more studies on Michigan and Idaho using the same methodology. These studies have not been released yet.
The second Study was done by NCFH. NCFH used Alice Larson's studies data and specially portrayed those into a software program called Geographic Information Services Software (GIS) which allows taking numbers and portraying them into a pictorial standpoint. Both Studies are available through the NCFH web site. Collectively, these studies represent 85% of the migrant farmworker population in the country, which are mostly concentrated in Washington, California, Florida, Texas , North Carolina, and Oregon . In addition, similar studies were conducted in other States that have not been studied before: Louisiana, Maryland, Mississippi, Oklahoma, and Arkansas . The study was conducted in the year 2000.
For her presentation today, Bobbi Ryder chose Texas' Study and will present only about one third of the slides, in the interest of time. The first slide described Alice 's Larson Studies. The other slides present a series of maps of the State of Texas' with the population size, estimated number of farmworker population, communities and migrant health center grantees, community only sites, number and size of counties, numbers by regions, etc. The Rio Grande Valley area in South Texas has the most significant number of farmworkers. The map shows 362,724 MSFWs in Texas . The map also shows 13 jointly funded Community and Migrant Health Centers (CMHC) in Texas , with sites in 29 counties and their location. There are 21 counties that do not have MHCs or CHCs. There is a significant capacity issue, largely uninsured/uncompensated population. Bobbi Ryder noted that "our health centers are doing a good job providing health services to the population but there still there is a large number of un-served, un-reached, uninsured migrant farmworkers that are living in much hidden parts of the country."
Anne Nolon asked if there is an overlay of the map of Texas with the poor counties, in order to know if there is a migrant population in these poor counties. Texas would be one of the more compelling States to do this overlay. Gilbert Walter added to the question: "Somebody in HRSA must be doing some work about this overlay." To these comments, Dr. Gomez replied that the list of poor counties has not been available to HRSA.
Bobbi Ryder mentioned that NAPs are designed for CHCs not for MHCs. There are several barriers when special populations apply for NAPs. She encouraged the NACMH to formulate recommendations on funding mechanisms. NAP funding mechanism does not work for MHCs.
Robert Scott stated that the expertise of the Central Office Grantees (COGs) is very important to the work of the NAMCH. He asked Bobbi Ryder if she could provide a list of recommendations and challenges that funding mechanisms has presented, and the rational for recommended changes. Bobbi Ryder responded that she will send a copy of the meeting minutes that was held in New Mexico to discuss the MHC applications for NAP. Dr. Gomez, three NAMCH members - Gilbert Walter, Anne Nolon and Guillermo Martinez - some CHC and MHC representatives, and the COGs where present in this meeting. The message during that meeting was that "this current funding mechanism is a "business model" to work best under the PI to get the dollars out quickly but is it not working for the MHCs", and it is not designed for a mobile population. Lack of applications should not be interpreted as a lack of need. They identified some barriers and came up with some suggestions. Bobbi Ryder is also willing to work collectively work with the other COGs and provide a document with the rationale to the NACMH. Gilbert Walter is willing to work with Bobby Ryder in the preparation of this document.
ACTION ITEM: Bobbi Ryder will send recommendations on funding mechanisms. She will provide the minutes from the New Mexico meeting, and will gather information from the COGs about this subject before the next meeting, February 5-6, 2007 in Washington , D.C. Gilbert Walter will also work in Bobbi Ryder in the preparation of this information. Council members will also work individually with her to collect this information.
ACTION ITEM: The Council will formulate recommendations on funding mechanisms.
HEALTH CENTER CURRENT/FUTURE FUNDING
• John Ruiz, Assistant Director, Department of Systems Development and Policy,
National Association of Community Health Centers
John Ruiz started his presentation by encouraging the NAMCH members to communicate with the Secretary about the funding mechanisms for the MHPs. He expressed that we are in a continued resolution, and conversations about appropriation will continue until after January 2007 for political reasons. The funding opportunities for the MHPs are very limited. There is no anticipation for Expanded Medical Capacity (EMC) awards. If there are not sufficient applicants under this funding opportunity (NAP), HRSA should look into the EMC as an opportunity to get further money to the MHPs and spend the proportional allocation for these programs. His understanding is that HRSA has indicated that if they need to go to the EMC route, they will be awarding funds to those applicants that applied in the previous EMC and were not funded. His concern is that there are no MHPs applications left in that pool of applications. There were 29 applications funded under that EMC. He urges the NACMH to make recommendations to use EMC funding mechanisms if the funds are available.
John Ruiz continued his presentation by adding that HRSA should have a separate application criteria for the MHP funding application. According to the Uniform Data System (UDS), MHPs served between 15-17% of the need based on the different estimates of total migrant population and their families. He also emphasized that the lack of MHPs applications should not be interpreted as a lack of need; the funding model utilized by HRSA to fund health centers discriminates the MHPs. The application criteria do not work for the MHPs. There might be a number of MHPs that will not be able to sustain. EMC is a good way to fund new MHPs and provide sustainability for those that are already operating. He encourages HRSA to work with current grantees using EMCs as a funding mechanism to be able to expand their services and reach the population.
Anne Nolon asked the following question: "Is there a pool of qualified migrant applications that was not funded in the last EMC round?". Dr. Gomez responded that all the MHP applications that were approved and scored within the range were funded - a total of 27. There might be one or two that might have a decent score (higher than 70-75) but not high enough to qualify over the others.
John Ruiz ended his presentation by stating that there is a potential threat to the proportional allocation (8.6%) for the MHPs. It is very important to maintain the proportional allocation. It is possible that if there are not sufficient takers for the funding opportunities, the message will be that there is no need for the proportional allocation and therefore it should not be maintained in the statute.
John Ruiz concluded that the NAMCH should request a study by HHS/HRSA about the funding for MHPS, what works and what does not work. He thanked for the opportunity to present to them.
DISCUSSION AND FUTURE PLANS
Discussion on the Draft Letter to the Secretary
All NACMH members thanked Anne Nolon for writing the initial rough draft letter inviting the Secretary to meet with them on the next NAMCH meeting, February 5-6, 2006.
Karen Watt expressed that this is a critical time to meet with the Secretary to expose the NACMH's recommendations.
Dr. Gomez asked the NAMCH to make sure that they have clear recommendations to the Secretary; not only exposing the problem, but presenting a solution to the problem. She also recommends to have all information ready prior to meeting with the Secretary, and to put all their thoughts together to make sure that they are "in the same page."
Robert Scott asked about the contents of the letter, specifically about the mention on the consolidated report of the last three hearings that will be presented to the Secretary. Anne Nolon expressed that this a good opportunity for the NACMH members to present a consolidated report to the Secretary. She already consolidated the hearings that took place in Tarrytown and San Diego , and she will be working on the third hearing from Uvalde , TX . She assured her colleagues that the report will be ready to present to the Secretary.
Rosita Castillo excused herself for leaving early. She expressed her gratitude to Anne Nolon for her leadership in writing the letter. She is in favor of a face-to-face meeting with the Secretary and offered her help when needed. Dr. Gomez thanked her for taking the time to join the conference call.
The following points were considered to be presented to the Secretary:
- Consolidated Report of NACMH Public Hearings
- The Farmworkers Access Study
- The funding mechanism
- The "Poor Counties Initiative"
- Maintenance of the MHP's proportional allocation
- Service expansion needs for dental/mental health
Robert Scott made the suggestion to limit the discussion with the Secretary to one item - health care barriers faced by migrant and seasonable farmworkers due to the funding mechanisms. He added that there might not be enough time to discuss all items mentioned above and even though everything is really important, he believes that the funding mechanism discussion is of relevant importance at this time.
After a discussion, all NAMCH members agreed to discuss the following when meeting with the Secretary: funding mechanism, consolidated report of NACMH public hearings, and the Farmworkers Access Study. Robert Scott and Anne Nolon will finalize the letter.
ACTION ITEM: The points to be discussed when meeting with the Secretary will be the funding mechanism, consolidated report of NACMH public hearings, and the Farmworkers Access Study; funding mechanism being the highest priority. Robert Scott and Anne Nolon will finalize the letter of invitation to the Secretary.
Karen Watt expressed her concern about the possibility that at the time of the meeting with the Secretary, the NACMH will have six new members. Dr. Gomez responded that the retiring members can still attend the meeting; however, she does not guarantee payment for travel expenses.
Discussion on Testimonies
Dr. Gomez reminded the NAMCH that according to the usual schedule of testimonies, the next one is supposed to take place in the East Coast this year. She added that it is up to the Council to decide when and where they should hold testimonies. Anne Nolon suggested holding testimonies at the East Coast Migrant Stream Forum. Dr. Gomez reminded them that that Forum is taking place in FY 08, which means that they would not have testimonies for FY 07. Karen Watt reminded the Council about the meeting with the Secretary; there will be a schedule conflict if the Council decides to have the testimonies in February in Washington , D.C. and the Secretary decides to hold the meeting with the Council at the same time. Robert Scott proposed to postpone this discussion and make it part of the Agenda for the February meeting. All Council members agreed.
ACTION ITEM: Include the testimonies' schedule discussion on the February meeting Agenda in Washington , D.C.
Agenda for next Council Meeting in Washington D.C.
All Council members agreed to send Agenda suggestions for the February meeting. These suggestions will be discussed with the Executive Subcommittee via conference call on December 12 th , 2007.
ACTION ITEM : The Council members will send Agenda suggestions for the February meeting. These suggestions will be discussed with the Executive Subcommittee via conference call on December 12 th , 2007.
The Chair thanked all participants for a very productive conference call.
ADJOURN
There being no further business, the Chair adjourned the meeting at 3:30 p.m.
NATIONAL ADVISORY COUNCIL ON MIGRANT HEALTH (NACMH)
ACTION ITEMS
Conference Call - November 15, 2006, 1:00 p.m. - 3:30 p.m.
ACTION ITEM: Bobbi Ryder will send recommendations on funding mechanisms. She will provide the minutes from the New Mexico meeting, and will gather information from the COGs about this subject before the next meeting, February 5-6, 2007 in Washington , D.C. Gilbert Walter will also work in Bobbi Ryder in the preparation of this information. Council members will also work individually with her to collect this information.
ACTION ITEM: The Council will formulate recommendations on funding mechanisms.
ACTION ITEM: The points to be discussed when meeting with the Secretary will be the funding mechanism, consolidated report of NACMH public hearings, and the Farmworkers Access Study; funding mechanism being the highest priority. Robert Scott and Anne Nolon will finalize the letter of invitation to the Secretary.
ACTION ITEM: Include the testimonies' schedule discussion on the February meeting Agenda in Washington, D.C.
ACTION ITEM : The Council members will send Agenda suggestions for the February meeting. These suggestions will be discussed with the Executive Subcommittee via conference call on December 12th , 2007. |
