NATIONAL
ADVISORY COUNCIL ON MIGRANT HEALTH (NACMH)
Meeting
May 4-5, 2008
San Juan, Puerto Rico
Meeting Participants
Council Members:
Rogelio Fernandez, M.D. (Chair)
Rosita Castillo Zavala (Vice
Chair)
Frances R. Canales
Susana Castro
Enedelia Cisneros
Michael DuRussel
Jose Manuel Gaytan
Roberto Gonzalez
Jose L. Lopez
John W. McFarland, D.D.S.
Robert S. Nimmo, Jr.
Christina Ramos
Diana Sanchez
Emma I. Segarra
Andrea Weathers, M.D., Dr.PH
Federal Staff:
Donald Weaver, M.D., Deputy Associate
Administrator, Bureau of Primary Health
Care
Capt. Henry Lopez, Jr., Director, Office
of Minority and Special Populations
Marcia Gomez, M.D., Designated Federal
Official (DFO)
Gladys Cate, NACMH Staff Support
Presenters:
Isolina Miranda, Executive Director, Corporación
de Servicios de Salud y Medicina Avanzada,
Inc. (COSSMA); Past Member, National Advisory
Council on Migrant Health
Edward Colon-Quetglas, M.D., Board Member,
Centro de Salud del Migrante – Mayaguez;
Past Member, National Advisory Council
on Migrant Health
Public:
Deliana Garcia, Migrant Clinicians Network
Gayle Lawn-Day, Ph.D., Migrant Health
Promotion
Keith Maxwell, Connecticut River Valley
Farmworker Health Program, Massachusetts
League of Community Health Centers
Karen Mountain, Migrant Clinicians Network
CALL TO ORDER AND WELCOMING REMARKS
- Rogelio Fernandez, M.D., Chair
Rogelio Fernandez welcomed Council members
and remarked that all members were in
attendance at this meeting.
Following a round of introductions of
Council members, staff, and guests, Enedelia
Cisneros announced the grand opening of
the new migrant farmworker medical clinic
in her area. Council members applauded
this important event.
Dr. Fernandez reviewed the agenda for
the meeting. John McFarland moved to approve
the agenda. The motion was seconded by
Susana Castro and carried unanimously.
The Council reviewed the minutes of the
February 2008 meeting. Roberto Gonzalez
moved to approve the minutes. The motion
was seconded by Michael DuRussel and carried
unanimously.
Dr. Fernandez introduced Isolina Miranda
and Edward Colon-Quetglas and turned the
floor over to them.
WELCOME TO PUERTO RICO
- Isolina Miranda, Executive Director,
Corporación de Servicios de Salud y
Medicina Avanzada, Inc (COSSMA); Past
Member, National Advisory Council on
Migrant Health
- Edward Colon-Quetglas, M.D., Board
Member, Centro de Salud del Migrante
– Mayaguez; Past Member, National Advisory
Council on Migrant Health
Isolina Miranda welcomed Council members
to Puerto Rico and informed them that
it is referred to as the “Isla del Encanto”
(“Enchanted Island”) because of its beaches
and natural beauty. She then provided
an overview of migrant health issues in
the island.
Ms. Miranda noted that the population
of Puerto Rico is 3.8 million. Forty-five
percent are living in poverty, and 12
percent are unemployed. The unemployment
rate is one of the highest in recent years,
because many industries are moving their
operations to other islands with cheaper
labor costs. In 2006, the five leading
causes of death in Puerto Rico were heart
disease, cancer, diabetes mellitus, cardiovascular
disease, and HIV/AIDS. These statistics
are very similar to those of the U.S.
mainland.
The Uniform Data System (UDS) Report
for 2006 showed that Puerto Rico had 19
Bureau of Primary Health Care (BPHC) grantees,
including 18 Community Health Centers
(CHCs) and one homeless program. The CHCs
have 48 delivery sites and five health
schools. In 2006, they served 363,973
users, with 1,479,891 patient encounters.
Ms. Miranda stated that the primary diagnoses
at CHCs in Puerto Rico reflect a high
prevalence of chronic conditions, including
hypertension, diabetes mellitus, heart
disease, asthma, depression, and substance
abuse. Noting that asthma, depression,
and substance abuse were not among the
top diagnoses for the general population
in Puerto Rico, Ms. Miranda attributed
their prevalence among CHC patients to
the fact that the clinics provide comprehensive
services to treat these conditions.
Ms. Miranda noted that six CHCs in Puerto
Rico receive migrant health funding. They
provide a comprehensive array of services,
including medical, oral, and mental health
care; prenatal care and family planning
services; laboratory and pharmacy services;
immunizations; nutritional evaluation;
social work services; health education;
health certificates; home visits; minor
surgery; disease prevention; and health
promotion. Some clinics also provide X-ray
services. One clinic provides temporary
shelter for patients with HIV/AIDS. In
2006, the centers operated 21 sites located
throughout the island. Migrant and seasonal
farmworkers (MSFWs) represented 15 percent
of the 179,386 patients seen at these
clinics and accounted for 711,619 service
encounters.
Ms. Miranda informed the Council that
the number of MSFW users in Puerto Rico’s
CHCs has decreased by 46% in the past
five years. This trend is due to a number
of factors, including industrialization
in the agricultural industry; changes
in the work environment; movement of MSFWs
into industries with better wages and
higher standard of living; hurricanes
and tropical storms; and the lack of incentives
and subsidies for farm owners to support
or improve production. Ms. Miranda noted
that many farms obtain workers through
contracts with prisons, which have their
own health systems, and many coffee farms
hire illegal residents, who are afraid
to seek health care services. In addition,
many agricultural workers lost their permanent
jobs and now do odd jobs or work their
own land to survive; they identify themselves
as unemployed, and not as farmworkers.
Finally, many migrants leave to work agricultural
jobs in the mainland without signing contracts
with the Department of Labor. Ms. Miranda
emphasized that the main issue is that
people are using migrant health services,
but they are not identifying as farmworkers.
CHCs in Puerto Rico are currently conducting
a drive to identify patients who are farmworkers.
Ms. Miranda outlined challenges to migrant
health in Puerto Rico. Agriculture does
not support the central economy, but it
plays an important role in economy of
some municipalities. CHCs need to reinforce
their outreach work to identify MSFWs
in their areas. In many cases, family
members work on the land, but only the
head of the family identifies himself
as a farmworker. The government-sponsored
Health Care Reform also presents a challenge,
because the compensation rate does not
cover the cost of services provided by
CHCs in Puerto Rico.
Ms. Miranda showed photographs of small
roadside farm stands, where local farmers
sell a wide variety of fruits and vegetables.
Coffee continues to be a small but important
crop in Puerto Rico and is considered
to be among the best in the world. Ms.
Miranda noted that there is currently
a shortage of 5,000-8,000 coffee pickers.
Other main crops are plantains, bananas,
and fruit. Most fruits and vegetables
are sold within Puerto Rico, but plantains
and bananas are also exported.
Ms. Miranda thanked the Council and opened
the floor for comments and questions.
Marcia Gomez: expressed surprise that
HIV/AIDS was not among the top causes
of death among CHC patients. Ms. Miranda
responded that effective treatments have
made HIV/AIDS a chronic disease, rather
than a terminal illness. More people are
dying from diseases such as diabetes and
hypertension than from AIDS. Puerto Rico’s
16-bed shelter for HIV patients, which
is supported with funding from the Department
of Housing and Urban Development and the
Department of Health, provides housing
for 16 male HIV patients. They can stay
at the shelter for up to two years; after
that, they can spend another two years
at one of several homes that were recently
built to provide these patients with additional
time to address their substance abuse
issues before they transition to the general
community. In response to a question from
Frances Canales, Ms. Miranda clarified
that the CHCs in Puerto Rico provide substance
abuse services.
Dr. Weathers asked about the origin of
farmworkers in Puerto Rico. Ms. Miranda
replied that most are local workers. She
clarified that Puerto Rican migrant farmworkers
are those who travel to the mainland for
work. They are usually male heads of family,
who migrate for approximately eight months
each year. The families remain behind,
and many of them receive health services
at migrant health clinics in Puerto Rico.
Ms. Miranda clarified that the number
of MSFWs seen at CHCs in Puerto Rico has
decreased because fewer patients are identifying
themselves as farmworkers; however, she
believes they are still receiving services
at the clinics. The Puerto Rico CHCs are
conducting an outreach effort to identify
the farmworkers at each of their clinics.
Responding to a question from Dr. Gomez,
Ms. Miranda stated that the amount of
land devoted to farming has not decreased
in Puerto Rico, but there are fewer farmworkers
because of industrialization. Small farmers
continue to work their own land and sell
their produce in roadside stands.
Frances Canales asked whether high gas
prices would affect the number of people
migrating to the mainland. Ms. Miranda
replied that, in many cases, companies
in the mainland hire workers on contract
and pay their travel expenses. These contract
workers do not register as migrants with
the Department of Labor. They make more
money, but they do not qualify for migrant
health services.
Responding to a question from Dr. Weathers,
Ms. Miranda replied that the CHCs provide
many services for children. There is a
high vaccination rate, and all CHC staff
are trained in identifying abuse. There
is a great demand for dental services,
because CHC pediatricians refer patients
to the dental clinic.
Dr. McFarland reminded the Council that
the need for oral health is very high
among migrant health center (MHC) patients,
but it does not appear on the list of
top five conditions because of how the
data collection system is designed. The
Council must continue to advocate for
including oral health in data collection
and reporting systems.
Responding to a question from Jose Lopez,
Ms. Miranda stated that the Health Care
Reform program does not affect the quality
of care at CHCs, but it does impact the
financial status of the clinics. Most
clinics try to subsidize unreimbursed
costs through fees collected from other
patients.
Ms. Castro asked about promotora services.
Ms. Miranda noted that they received funding
from the Robert Wood Johnson Foundation
eight years ago to support promotoras.
The project was so successful that they
recently received additional funding from
Johnson & Johnson.
Dr. Fernandez thanked Ms. Miranda for
her presentation and turned the floor
over to Dr. Edward Colon.
Dr. Colon provided an informative overview
of the geography, history, and political
structure of Puerto Rico. He noted that
the island has the second highest population
density in the world, with more than 4
million people living in 3500 square miles.
Dr. Colon noted that the clinic in Mayaguez
has a homeless program and works with
the municipality to provide shelter space.
However, there is little interest in using
the shelters because the benign weather
makes it easy to survive in the open,
and most of the homeless are addicted
to substances and do not like to be supervised.
Dr. Colon acknowledged that it is an ongoing
struggle to get homeless patients into
treatment. The clinic has approximately
900 homeless patients, but it only has
funding for 30 substance abuse patients.
Dr. Colon cited two reasons for the diminishing
number of MSFWs seen at clinics in Puerto
Rico. First, many Puerto Rican farmworkers
establish contacts with other types of
businesses in the mainland and no longer
migrate; their families join them eventually.
The second reason is that they are reluctant
to be identified as farmworkers, because
they lose many benefits they receive in
the island.
Responding to comments from Dr. Weathers,
Dr. Colon confirmed that the issue of
unauthorized patients is not as great
in Puerto Rico as it is on the mainland
and that barriers to care are mostly non-financial.
Responding to questions from Ms. Canales
and Ms. Castillo, Dr. Colon stated that
substance abuse is a problem among males
who migrate as well as the families who
stay behind. He noted that the primary
substance abuse problem among male MSFWs
was alcoholism. Trends in drug abuse come
in waves. At present, cocaine use is more
prevalent than intravenous drug use.
Diana Sanchez asked whether colorectal
and breast cancer screenings were as high
a priority in Puerto Rico as they are
in the mainland. Dr. Colon replied that
breast screenings are provided by CHCs,
but it is difficult to meet the requirements
established by the Health Care Reform
to obtain a referral for colorectal screenings.
Responding to a question from Michael
DuRussel, Dr. Colon explained that Puerto
Rico receives a lump sum for Medicaid;
this amount is not sufficient to meet
the cost of services that are provided.
Puerto Rico has been fighting this arrangement,
but it does not have representation in
Congress. Dr. Colon noted that residents
of Puerto Rico do not pay federal income
tax, unless they work for the federal
government. However, the local income
tax brackets are higher than those for
federal income tax, because it is the
only source of income for the Puerto Rican
government. The median income is $8700,
and the average family income is approximately
$17,000, which is the lowest in the nation.
Responding to Robert Nimmo, Dr. Colon
noted that unemployment is usually about
8%, but it is now at 12% because many
manufacturing industries have closed in
recent years. He noted that workers in
Puerto Rico get the federal minimum wage,
while the minimum wage in the Dominican
Republic is 60 cents per hour.
Dr. Weathers asked Dr. Colon to identify
the major concerns of migrant farmworkers
in the future. He first noted that health
care reform, which started in 1994, has
completely changed the view of health
care for average citizens, including migrants.
He also noted that the children of MSFWs
are finding other ways of making a living
and do not want to do agricultural work.
Dr. Fernandez thanked Dr. Colon for his
presentation and turned the floor over
to Henry Lopez.
Bureau of Primary Health Care
(BPHC)/Office of Minority and Special
Populations (OMSP)
- Capt. Henry Lopez, Jr., Director,
OMSP
Henry Lopez welcomed Council members
to the meeting. He emphasized that the
Council plays a vital role and urged the
Council to use its voice to help those
it serves.
Capt. Lopez informed the Council that
he has organized OMSP staff into two teams.
Dr. Gomez heads the migrant health team,
which also includes Gladys Cate and Annette
Nelson. Capt. LaVerne Green heads the
team that works with the homeless, public
housing, and school-based programs. This
structure reflects Capt. Lopez’s belief
that he is not indispensable, and it is
essential for more than one person to
know the programs.
Capt. Lopez expressed his commitment
to maintaining partnerships with the Council
and the Central Office Grantees to ensure
that the Council’s work is successful.
He reminded Council members that he has
an open door policy. He welcomes their
ideas and suggestions to improve the work
of the Council.
Capt. Lopez informed the Council that
the HRSA’s efforts to standardize its
operations are coming to fruition. One
aspect of this process was the Baseline
Scope Verification (BSV). All HRSA grantees
were asked to verify the accuracy of the
information in the HRSA database pertaining
to their organization. All grantees responded
to this request, and the new baseline
data will streamline future grant applications.
Clinical performance measures have also
been standardized, and reporting procedures
have been streamlined to more clearly
document the results of HRSA’s programs
and justify budget requests submitted
to Congress. HRSA is currently looking
into how to accurately document services
provided to migrant populations, using
five clinical measures: diabetes, hypertension,
immunization, pap tests, and entry into
prenatal care. HRSA’s Electronic Handbook
is also being standardized.
Capt. Lopez reminded the Council that
the Policy Information Notices (PINs)
that establish the rules for grantees
always have a period for public comment.
He noted that Dr. Gomez would provide
Council members with a copy of the PINs
that are relevant to migrant health, and
he urged them to review and comment on
them. He requested that Council members
submit their comments through the OMSP
so that he and Dr. Gomez would be aware
of the issues they raise.
Capt. Lopez turned to a discussion of
the PIN on shortage designation regulations,
which could impact health centers throughout
the country. He informed the Council that
the comment period had been extended to
the end of May due to the volume of comments
received and the concerns that were expressed.
Capt. Lopez noted that the Council’s comments
were instrumental in getting the comment
period extended.
Capt. Lopez informed the Council that
HRSA recently conducted a competition
for the cooperative agreements with the
Central Office Grantees that provide training
and technical assistance to migrant health
grantees. The results of the competition
will be announced on July 1.
Capt. Lopez stated that he and Dr. Gomez
would be conducting site visits and providing
technical assistance, through the Migrant
Cooperative Agreements, to migrant health
centers in the near future. He then opened
the floor for discussion.
Dr. Gomez acknowledged that Capt. Lopez
is a strong advocate for the Council and
had been instrumental in obtaining the
necessary approvals for this meeting.
John Ruiz expressed his appreciation
for the commitment and openness that Capt.
Lopez brings to his position. He then
raised the issue of a recent case in which
a CHC physician who provided emergency
care was denied malpractice coverage under
the Federal Tort Claims Act (FTCA) because
the patient was not a health center patient.
He stated that this creates an ethical
dilemma for providers. Mr. Ruiz noted
that NACHC is attempting to obtain clarification
and asked whether this issue was on the
Council’s agenda.
Capt. Lopez stated that HRSA was aware
of the issue and was trying to address
it. The Council had a discussion about
the following: 1) providers were purchasing
additional insurance; 2) some providers
were declining to work in health centers.
It was summarized that because of concerns
about FTCA this case is forcing many issues
to come to the table. In the meantime,
it is important to for health centers
to look at the agreements with partner
organizations to determine when providers
will and will not be covered.
Dr. Gomez reminded the Council that its
purpose is to represent MSFWs and to look
at these issues from a public health perspective.
The key question to ask when considering
a recommendation is how this issue will
impact the ability to provide health care
services to MSFWs.
Mr. Ruiz noted that CHCs receive funding
from many sources, which makes it complicated
to provide services. It is important for
health center staff to know how to communicate
these issues to patients so they can understand
it.
Dr. Fernandez thanked Capt. Lopez for
his presentation and moved to the next
item on the agenda.
COUNCIL MEMBERS DISCUSSION
Dr. Fernandez opened the floor for discussion
by Council members. The ensuing discussion
covered several key topics, including
issues related to the letters to the Secretary;
testimonies; the meeting schedule for
Fiscal Year 2009 (FY09); future reports
from Central Office Grantees, and Council
membership.
Letters to the Secretary
Dr. Fernandez felt that the Council should
submit a letter when there are issues
that need to be addressed, but not necessarily
one per meeting. He noted that the Council’s
last letter to the Secretary took a different
approach from and focused primarily on
one issue (i.e., outreach).
Mr. DuRussel asked whether every letter
needed to include recommendations. He
suggested that the Council consider sending
a courtesy letter to thank the Secretary
for responding to its previous requests.
Dr. Fernandez acknowledged that the Secretary
had addressed a number of issues that
the Council identified in recent letters.
Dr. Gomez noted that the legislative
mandate requires the Council to submit
recommendations, although it does not
specify the frequency of the letters.
Testimonies
Council members agreed that testimonies
provide an important first-hand perspective
that helps the Council formulate its recommendations,
and there was a consensus that one meeting
per year should be devoted to testimonies.
Dr. McFarland emphasized that testimony
sessions must be structured carefully
if they are to be useful. Dr. Gomez noted
that OMSP needs additional lead time to
manage these logistics. She asked the
Council to provide as much advance notice
as possible regarding the timing, topics,
and speakers for the next round of testimonies.
There was a consensus that testimonies
should be on the agenda for the November
meeting.
Mr. DuRussel observed that some people
prefer written statements to oral testimonies.
Dr. Gomez noted that a verbatim transcript
is prepared following each session of
testimonies.
Ms. Canales asked whether future meetings
could include site visits. Dr. Gomez stated
that it is difficult to take a group of
this size to a working farm, because it
interrupts the operations.
Meeting Schedule
Council members agreed that they should
meet in Washington once a year and receive
testimonies once a year.
Dr. Gomez noted that the November meeting
in New Orleans would be the first meeting
for FY09. It would dovetail with the Midwest
Stream Farmworker Health Forum, conducted
by the National Center for Farmworker
Health (NCFH). As requested by the Council,
OMSP will make arrangements for testimonies.
The second meeting for FY09 would be held
in Washington, D.C. Dr. Gomez suggested
that the Council consider holding its
third meeting for FY09 in the Western
region. She noted that the 2009 National
Farmworkers Health Conference would be
held in San Antonio, which is in the Midwest
region.
Capt. Lopez noted that the 2008 Primary
Health Care All-Grantee Meeting would
be held in the Washington area June 23-25.
He hoped that it would be possible for
some Council members to attend that meeting.
Future Reports from Central Office Grantees
Dr. Gomez provided an overview of the
issues addressed by each if the six Central
Office Grantees (COGs). She asked Council
which groups it would like to invite to
make presentations, and how it would like
to structure the updates.
Dr. McFarland noted that Migrant Clinicians
Network (MCN) had not presented at previous
meetings. He suggested that they be invited
to make a presentation at the November
meeting.
Dr. Fernandez suggested inviting each
grantee to present once a year, which
would work out to two grantee presentations
per meeting. The grantees would be asked
to submit a written report at the time
of their presentation, although they could
provide written updates more often, if
desired.
Ms. Castro thought that it would be most
effective to focus on one major issue
at each meeting.
Council Membership
Dr. Gomez reminded the Council that two
positions would be open as of November.
She noted that she had not received any
nominations from Council members and urged
them to submit nominations within the
next two weeks.
Ms. Cisneros stated that it would be
important to have a dentist on the Council
when Dr. McFarland’s term expires. She
and Ms. Canales also stressed the importance
of having farmworkers represented on the
Council. Dr. Fernandez agreed and stated
that migrants are the most important members
of the Council.
Responding to a question about the composition
of the Council, Dr. Gomez explained that
the Council has 15 members. Twelve must
be Board members of a Section 330 program;
nine of those must also be users of Section
330 services. The other three positions
are for clinicians or administrators.
Noted that an individual who is appointed
as a Board member could be a clinician.
Council currently has three clinicians.
Dr. McFarland noted that the nomination
process was complex and intimidating,
and it is frustrating when strong candidates
are rejected. Dr. Gomez responded that
OMSP can provide assistance with nominations,
and she noted that some candidates who
are rejected the first time they are nominated
could be appointed to the Council at a
later date.
Other Issues
Roberto Gonzales noted that he serves
as secretary of a prevention program for
farmworkers in California. He described
situations of pesticide exposure at peach
orchards and expressed concern that regulations
were not being enforced, and he asked
whether this organization could send a
letter to the Secretary. Mr. DuRussel
and Dr. Fernandez thought that this should
be handled at the state level. Dr. Gomez
suggested that the Council could express
concern about this situation in one of
its letters to the Secretary.
Dr. Weathers asked how the Council’s
work was documented. Dr. Gomez stated
that the minutes of each meeting are posted
on the website, but she emphasized that
the Council’s recommendations were the
most important documentation.
Presentation of HRSA/BPHC Website
- Gladys Cate, Staff Assistant to Council
Ms. Cate provided an informative overview
of the HRSA website (www.hrsa.gov). She
noted that the home page has a link to
each of the Bureaus across the top, plus
a separate heading for six key topics:
grants, service delivery; health system
concerns, data, finding help, and HRSA
organization.
Ms. Cate informed Council members that
the NACMH website is once again included
within the HRSA website. It can be accessed
by clicking on the link for “Primary Health
Care” at the top of the HRSA home page,
then clicking on “Special Populations”
under the heading “About Health Centers.”
The link to the NACMH website appears
on the Special Populations page under
the heading “Migrant Health Centers.”
Ms. Cate noted that the NACMH website
has a home page with a list of members;
a section for Meetings, which includes
minutes going back to 2006; and a section
for Recommendations, which includes the
Council’s letters and recommendations
going back to 2004. Ms. Cate is working
with HRSA technical staff to post the
testimony transcripts on the site.
Dr. Fernandez thanked Ms. Cate for her
presentation and expressed his appreciation
for OMSP’s assistance in getting the Council’s
website back online.
Consolidation Act of 1996 &
Migrant Health Program
- Marcia Gomez, M.D., Designated Federal
Official
Dr. Gomez provided an overview of the
history and legislative foundation of
the Council. After noting that the full
text of the Consolidation Act (Public
Law 104-299) was included in the notebook
for this meeting. She informed Council
members that the NACMH was established
in 1975 to ensure that MSFWs would have
permanent representation at the Secretary’s
level.
Dr. Gomez stated that the Migrant Health
Program was initially created in 1962.
The Consolidation Act of 1996 was enacted
to address concerns that programs for
special populations—including the Migrant
Health Program—were not receiving equal
treatment by merging these services into
one law. The legislation stipulates that
the NACMH is to provide advice to the
Secretary regarding Section 330 Health
Centers, specifically those that serve
MSFWs (Section 330(g) grantees).
Dr. Gomez noted that the first page of
the law (page 3626) defines Section 330
Health Centers and specifically designates
MSFWs as a medically underserved population.
She noted that health centers are required
to provide services for all residents
within their catchment area, regardless
of ability to pay.
Referring to the situation that Mr. Gonzalez
described during the open discussion,
Dr. Gomez pointed out that the paragraph
on injury prevention programs on page
3638 stipulates that Section 330(g) grantees
must provide special occupation-related
health services for MSFWs, including programs
to prevent exposure to unsafe levels of
pesticides. Dr. Gomez stated that if
the Council decided to draft a recommendation
regarding pesticide exposure described
by Mr. Gonzalez, it could reference this
section of the law. She suggested that
the recommendation could include training
and technical assistance provided by the
Central Office Grantees to help educate
health centers and the public about pesticide
exposure. She noted that enforcement of
regulations should be addressed by the
Department of Labor or the Environmental
Protection Agency; the Migrant Health
Program would focus on education and prevention
of health matters. Ms. Canales and Mr.
DuRussel noted that many growers conduct
workshops to educate their workers about
issues related to pesticide exposure.
Dr. Gomez noted that Section 330 (g)
on page 3634 defines Migratory and Seasonal
Agricultural Workers for the purposes
of Health Center eligibility and ensures
that families of MSFWs are eligible for
migrant health services, as are MSFWs
who have retired or are unable to work
due to disability. She acknowledged that
this definition might differ from the
one used by the Department of Labor. Dr.
Gomez noted that the definition of “agriculture”
for the purposes of this legislation was
provided on page 3635.
Dr. Gomez discussed PIN 98-23 (Health
Center Program Expectations), which was
included in the meeting notebook. This
document, dated August 17, 1998, set forth
the program expectations for all Section
330 grantees, including those serving
MSFWs and their families.
Dr. Gomez discussed PIN 94-7 (Migrant
Health Voucher Program Guidance). This
PIN created the voucher program as a mechanism
to provide services to MSFWs and their
families in areas where the population
does not justify establishing a migrant
health center, existing provider organizations
cannot qualify, and existing providers
have the capacity to meet the needs.
Dr. Gomez described voucher programs
and the range of services that Section
330 grantees are expected to provide in
response to questions from new Council
members.
Dr. Fernandez thanked Dr. Gomez for her
presentation and turned the floor over
to Ms. Castillo.
Recap for Next Day
- Rosita Castillo-Zavala, Co-Chair
Ms. Castillo summarized the information
presented by Ms. Miranda and Dr. Colon.
She noted that many of the conditions
and challenges in Puerto Rico are similar
to those on the mainland, although immigration
issues do not present as much of an obstacle.
Ms. Castillo noted that there was consensus
among Council members regarding the importance
of hearing testimonies at one meeting
each year and the value of an annual presentation
by each Central Office Grantee.
Ms. Castillo thanked Capt. Lopez, Dr.
Gomez, and Ms. Cate for their open-door
policy and their efforts on behalf of
the Council.
Jose Lopez moved to adjourn. Enedelia
Cisneros seconded the motion, which carried
unanimously. The Chair adjourned the meeting
at 3:30 p.m.
MONDAY,
MAY 5
Dr. Fernandez called the meeting to order
at 9:00 a.m. After welcoming Council members
and introducing the guests in attendance,
he reviewed the agenda for the day. He
then introduced John Ruiz and turned the
floor over to him.
The Future of Migrant Farmworkers
Health
- Mr. John Ruiz, Director, Health Systems,
National Association of Community Health
Centers (NACHC)
Mr. Ruiz began by providing an overview
of the National Farmworker Health Conference.
He then discussed key trends in agribusiness
and farm labor in the 21st century, from
a recent paper by Philip Martin. The
first trend he identified was increasing
market concentration, with fewer small
farms and more big suppliers and shippers.
Much of this is driven by profits and
costs. For example, farmers are choosing
to raise corn for ethanol because it is
more profitable, or to raise lettuce because
it is easier to ship. Mr. Ruiz also noted
that rising costs could lead to an increase
in crops grown for export.
Mr. Ruiz stated that he had spoken to
farmworkers across the country regarding
the impact of immigration reform. He noted
that many immigrants are going underground
in response to new regulations passed
by localities across the country.
Mr. Ruiz mentioned that it is difficult
to make a prediction about agricultural
jobs, especially in an election year.
He cited promising examples of collaboration
and compromise between farmworker advocates
and growers. Mr. Ruiz noted that Congress
was working with the Bureau of Labor to
modify the H2A visa program. Some of the
changes could be detrimental to farmworkers,
such as the proposed elimination of housing
vouchers.
Mr. Ruiz stated that a major trend in
the agricultural labor force is the growing
number of indigenous populations. For
example, California now has many Thai
guest workers, and this is likely to increase.
Mr. Ruiz noted that growers are looking
for alternatives that will enable them
to be in compliance with immigration reform.
One of those alternatives is the guestworker
program.
Turning to a discussion of HRSA’s programs,
Mr. Ruiz noted that the new administration
would bring new leadership to the agency.
He emphasized the importance of understanding
the proposed changes to the shortage designation,
which the Administration would like to
finalize before the election. NACHC recently
sought clarification as to whether CHCs
would be eligible for future funding if
their catchment area no longer met the
definition of a shortage area. HRSA responded
that this was not the intention of the
proposed policy. Mr. Ruiz informed the
Council that NACHC is working with the
Primary Care Associations (PCAs) to assess
the impact of the proposed changes. He
noted that the extension of the comment
period was due to the volume of comments
received, and he thanked the Council for
commenting on this issue in its most recent
letter to the Secretary. Mr. Ruiz hoped
that there would be sufficient comments
during the extension period that HRSA
will be willing to go back to the table
and discuss the proposed changes with
all interested parties.
Mr. Ruiz informed the Council that NACHC
was recommending a $248 million increase
in funding for CHC programs, including
approximately $20 million for MHCs. He
noted that NACHC was working with all
of the presidential candidates on the
issue of health care reform and universal
health care and would continue to work
with the new administration. NACHC’s position
is that people need access to health care,
regardless of what type of coverage they
have. Mr. Ruiz noted that the current
budget deficits would affect funding for
discretionary programs, no matter who
is elected.
Mr. Ruiz introduced NACHC’s Access for
All America (AAA) plan. He noted that
the key components of the plan are to
preserve, strengthen, and expand the CHC
program. The goal is to serve 30 million
patients by 2015, which would represent
a doubling of the program. NACHC is urging
states to develop their own AAA plans,
because NACHC cannot do it alone. Mr.
Ruiz emphasized that it would take targeted
funding, and a new funding model, to achieve
the AAA plan of doubling the size of the
CHC program. Mr. Ruiz noted that the NACHC
had repeatedly raised concerns about mechanisms
to fund programs for special populations.
He also noted that funding decisions are
based on data, but no one has accurate
data on the number of farmworkers in the
U.S. Estimates range from 1.5 to 3 million.
Mr. Ruiz stated that, no matter what the
numbers are, the UDS data indicate that
CHCs are only serving 15 to 20 percent
of the farmworker population.
Mr. Ruiz described the four pillars of
the AAA plan: revenues, workforce, capital,
and support. Revenue streams include authorizations,
appropriations, and the Prospective Payment
System (PPS). Workforce strategies will
be essential to achieve the goal of the
AAA plan, given the chronic shortage of
primary care providers. Capital will be
required to fund infrastructure construction.
Support would ideally include PINs for
funding, outreach, health information
technology, and service expansion.
Mr. Ruiz identified issues to position
the migrant health program for the future.
First, there is a critical need for accurate
data, because money follows data. Second,
it is important to determine whether the
performance measures that are currently
in place are the right measures for this
patient population. Third, it is essential
to identify who the farmworkers are, where
they are, and what their health needs
are in order to provide appropriate health
care. Finally, it is essential to look
at the model and determine whether it
is a migrant health program or a farmworker
program. Mr. Ruiz noted that the Council
plays an important role in advocating
for these issues within HRSA and BPHC,
because it is an independent voice with
a direct link to the Secretary.
Mr. Ruiz noted that the Federal role in
the CHC program is diminishing; migrant
health is the only area receiving increases.
NACHC is working with the National Farmworker
Alliance to develop a comprehensive model
program that includes all services.
Mr. Ruiz provided an update on portability
initiatives. The meeting that was held
in March in Washington, D.C. with representatives
of PCAs, Head Start, and Maternal and
Child Health came up with two models.
One model would allow out-of-state billing,
utilizing a registry. The other model
would be a multi-state project. Both of
these models involve extensive collaboration
between state Medicaid agencies, the PCAs,
and health centers.
Mr. Ruiz emphasized the need to diversify
funding and suggested other federal agencies
and foundations as possible sources. He
noted that California is looking at ways
to obtain funding for migrant health from
the U.S. Department of Agriculture (USDA).
Mr. Ruiz called attention to several
innovative campaigns to raise awareness
of farmworker issues, and he noted that
the Internet is a powerful tool to increase
visibility of issues. He noted that Julia
Perkins of the Coalition of Immokalee
Farmworkers would speak at the conference
on her organization’s effective Internet
campaign, which led major corporations
to increase the price they pay for tomatoes.
Mr. Ruiz closed by urging Council members
to attend the plenary sessions at the
Conference and to take advantage of the
opportunity to ask questions and network
with experts. He noted that the keynote
speaker would be John Bowe, author of
Nobodies: Modern American Slave Labor
and the Dark Side of the Global Economy.
The book’s central message is that abuses
will continue without good rules to protect
rights of workers, and mechanisms to inform
workers of those rights.
Mr. Ruiz opened the floor for questions.
Dr. McFarland asked Mr. Ruiz to comment
on the Frew case, which resulted in a
$1.67 billion settlement to provide Medicaid
payments nationally to children of women
enrolled in Texas Medicaid. Karen Mountain
of the Migrant Clinicians Network provided
additional information on this case and
noted that it could be an excellent model
for addressing reciprocity issues. To
date, only three health centers have signed
up to participate, including one in Minnesota.
There is a need to increase participation
to demonstrate that this model can be
successful. Mr. Ruiz noted that this
issue would be addressed in a session
at the conference.
Dr. McFarland noted that Mr. Ruiz had
asked the Council to draft recommendations
addressing the need for an outreach PIN
and guestworker rules. He asked Mr. Ruiz
if NACHC could provide background information
or proposed language for these recommendations.
Mr. Ruiz stated that NACHC would provide
assistance and promised to contact experts
in these areas following the conference.
- ACTION ITEM:
NACHC will contact experts in the areas
of outreach and guestworker rules and
will assist the Council in making recommendations
in these areas by providing background
information and proposed language.
Mr. DuRussel expressed concern that Medicaid
portability could lead to “turf wars”
between states. Dr. Gomez acknowledged
that it would be challenging to come up
with a system that is acceptable to all
states. States have different eligibility
rules, and many migrants do not meet the
residency requirements.
Dr. Gomez acknowledged the Council’s
interest in the issue of Medicaid portability
and noted that some members would not
be able to attend the presentation at
the NACHC conference. She reminded the
Council that they could meet via conference
call at any time, and she urged them to
develop a recommendation to address this
issue.
Dr. Fernandez thanked Mr. Ruiz for his
presentation and opened the floor for
the Subcommittee Reports.
Subcomittee Reports
Access, Resource, and Funding
Ms. Castro reported that much of the
Subcommittee’s discussion was focused
on issues related to access. She emphasized
that access to services is crucial for
migrant health, especially with trend
toward people going underground. The Subcommittee
expressed concern that some counties require
proof of residency to receive services,
which frightens some prospective patients.
Council members noted that these requirements
should not apply to migrants.
The Subcommittee discussed issues related
to continuity of care. For example, children
with braces must see an orthodontist on
a regular schedule. Migration interrupts
their treatment, because most orthodontists
will only treat their own patients; when
they return from migration, the children’s
orthodontists will not see them if they
have missed two months of treatment. This
problem is compounded by the fact that
children over 18 no longer qualify for
Medicaid, and many migrant families cannot
afford to pay for these expenses.
The Subcommittee identified rising food
costs as another potential barrier to
care, because they limit access to healthier
food. Ms. Canales noted that it is cheaper
to get hamburgers from the dollar menu
at McDonalds than to buy ground beef for
a family of five. The Subcommittee suggested
that the Council explore potential collaborations
with USDA.
In the area of resources, the Subcommittee
discussed the need to find sources of
funding for specialty services to which
migrant patient are referred.
Public Policy and Advocacy
Ms. Castillo presented the report for
this Subcommittee. She noted that the
Migrant Health Program currently serves
only 15-20% of the estimated MSFW population
and stressed the need for accurate data.
In order to serve this population effectively,
it is essential to know who they are,
especially the proportion of males to
females; where they are; and what their
migration patterns are. The Subcommittee
suggested conducting pilot projects where
farmers and clinics would collaborate
to obtain this information. Farmers should
advocate for farmworker health, because
they benefit from a healthy workforce.
The Subcommittee noted that many farmworkers
are not aware of state and county health
care programs. Ms. Castillo suggested
that these programs be reviewed to identify
what services are available in order to
direct funding where it can have the greatest
impact.
Migrant Health Services
Dr. McFarland presented the report for
this Subcommittee. He expressed concern
that MHCs do not see a large enough percentage
of the MSFW population. The current utilization
rate of 800,000 patients is unsatisfactory,
regardless of whether the total population
is 3 million or 5 million. It is unrealistic
to expect 100% utilization, but 80% is
a reasonable expectation for the general
population. The only way to reach that
goal is to expand capacity and access.
Dr. McFarland emphasized the need to obtain
accurate data to find out where migrant
populations are located now, and build
clinics there.
Dr. McFarland stated that the migrant
health model is as good as any health
care system in the country, if it is implemented
properly. MHCs should provide comprehensive,
prevention-oriented primary care, which
includes medical care, oral health care,
and behavioral health care. They should
address the unique needs of migrants,
including environmental issues such as
pesticide exposure and sanitation. They
should also provide outreach and facilitation
services as well as access to specialty
services.
The Subcommittee recommended that the
Council take the following actions:
- Develop recommendations regarding
an outreach PIN and guestworker rules,
as requested by NACHC
- Continue to support the Migrant Head
Start/Medicaid oral health portability
study.
Dr. Weathers made several additional
comments. She first stated that it is
important to recognize that it is impossible
to truly enumerate this population, given
the rate at which the labor market is
shifting. However, representative data
are sufficient to inform decisions about
health services use. Dr. Weathers then
stated that the fact that 15-20% of MSFWs
are accessing health services does not
mean that the remaining 80-85% are experiencing
barriers to access. Finally, Dr. Weathers
stated that while comprehensive care is
the gold standard, it is difficult to
provide this level of care with a mobile
workforce. She suggested that the Council
consider the benefits to migrant farmworkers
of medical models that provide acute care—such
as urgent care centers—in areas with insufficient
numbers of migrants to support a comprehensive
community health center.
Ms. Canales suggested that the utilization
rate may be declining because migrants
cannot afford the specialty services that
are recommended by physicians. Dr. Fernandez
stated that this underscores the need
for physicians who understand that MSFWs
have limited access to specialty services.
He acknowledged that this is difficult
in a voucher program.
Ms. Canales stressed the importance of
electronic health records to improve portability.
Dr. Fernandez stated that universal health
care and electronic medical records are
important, but they would only help those
with legal status. He noted that approximately
70% of the patients at California health
centers are undocumented.
Enumeration of MSFWs
- Roberta Ryder, National Center for
Farmworker Health (NCFH)
Dr. Fernandez introduced Ms. Ryder, who
presented an overview of the history and
process of estimating farmworker populations.
Prior to her presentation, Ms. Ryder
discussed the schedule for the Midwestern
Stream Forum in New Orleans in November.
The opening plenary session will take
place at 1:00 p.m. on Thursday, November
20. She suggested that the Council plan
to meet on November 18 and 19. NCFH has
already reserved accommodations and meeting
rooms for the Council at the conference
hotel.
Ms. Ryder informed the Council that crop-based,
demand for labor (DFL) is the most common
methodology for estimating MSFW populations.
The formula is derived by multiplying
the number of acres devoted to a given
crop in a certain location by the number
of manpower hours required per acre to
get the harvest in.
Ms. Ryder noted that it is important
to distinguish between estimation and
counting. She emphasized that it is important
to know the number of MSFWs, where they
are, and when they are there. None of
the estimation methods is perfect, but
it is difficult to do a census-type count
with a mobile population.
Ms. Ryder reviewed the studies that had
been conducted over the past 50 years
to estimate farmworker populations. These
include the Atlas of State Profiles
published by the Office of Migrant Health
(1989); the Larson Enumeration Studies,
2000-2008; and the NCFH local area estimation
methodology; and the report of the Bio
Statistical Expert Group (July 2007),
which was convened to review and validate
the methodology for the NCFH estimation
and other studies.
Ms. Ryder presented several key questions
that affect how these studies are designed:
- Why do we need this information, and
what will we do with it when we have
it?
- Who are the potential users of the
information?
- What information do we need to collect
to meet the stated need? What definitions
will we use?
- How will we collect the information,
how much will it cost, and how will
we present it?
Ms. Ryder noted that it is essential
to agree on definitions in order to determine
who will be included in the count. She
noted that federal regulations use several
different terms, including “farmworker,”
“seasonal agricultural worker,” and “migratory
agricultural worker.” The definition of
agriculture in the federal regulations
sounds inclusive (“Farming in all of its
branches”), but the interpretation varies
widely at the local level. Ms. Ryder illustrated
this point with a table that showed the
different industries that are included
and excluded in this definition by different
federal departments.
Ms. Ryder listed a wide range of local
factors and variables that can impact
data, including:
- What is happening in the agricultural
industry in general?
- What is happening with farmworkers
(e.g., weather, economic conditions)?
- Are workers employed full time or
part time? (Shortage or surplus of labor?)
- Are workers crossing back and forth
between agriculture and other types
of work?
- Are workers leaving agriculture for
other types of work?
- Solo males vs. families
- Number of dependents
- Housing availability vs. homeless
- Reported income vs. cash payments
- Crew leaders vs. employment status
Ms. Ryder noted that researchers often
consider local factors to supplement official
data sources, such as agricultural crops
and production using hand labor, and the
number of person hours it takes to conduct
specific agricultural tasks. She invited
Council members to identify factors they
thought would be important to consider.
Ms. Canales noted that last year there
were more women than men working at the
packing plant where she works, and it
was very difficult to find male workers.
Ms. Castillo noted that migrant men in
the Seattle area also work in construction
and restaurants. Ms. Ryder noted that
federal regulations state that a farmworker’s
“principal” source of income must be through
agriculture.
Ms. Ryder noted that data from estimation
studies help service providers know where
the farmworkers are and when they are
there. Estimation studies also provide
important data for grant applications,
and they provide absolute and threshold
numbers that help planners make informed
decisions.
Ms. Ryder provided the Council with a
list of official data sources:
- North American Industrial Code System
(NAICS), from the Census Bureau
- Quarterly Census of Employment and
Wages (QCEW), from the U.S. Department
of Labor, Bureau of Labor Statistics
- Census of Agriculture (COA), from
USDA
- National Agricultural Worker Study
(NAWS), from the U.S. Department of
Labor
Ms. Ryder showed Council members how
to access enumeration data on the NCFH
website (www.ncfh.org).
The website includes data from the Larson
studies, GIS mapping based on the Larson
studies that illustrates the locations
of MSFW populations, MHCs and CHCs, by
counties.
Ms. Ryder noted that the Larson numbers
are not perfect, but they are very useful.
NCFH is trying to create a tool that health
centers can use to obtain the data they
need. She anticipated that the preliminary
tool would be available by the end of
June. NCFH is currently comparing data
obtained through this tool to the Larson
study to validate the methodology.
Ms. Ryder presented data from a study
that NCFH conducted for Connecticut River
Valley, which used the DFL methodology
to determine agricultural employment by
month and cumulative agricultural employment,
adjusted for underreporting and for family
members. The data obtained using this
methodology matched QCEW data at the peak
of season.
Ms. Ryder opened the floor for discussion.
Dr. McFarland asked if the NCFH had an
updated estimate of the national farmworker
population. Ms. Ryder stated that they
did not develop the methodology to obtain
a national estimate. However, she believed
it could be used to validate an estimated
population of 3.5 million farmworker and
family members, including the aged and
disabled.
In response to a question from Dr. Weathers,
Ms. Ryder stated that the most recent
data on the national farmworker population
were nearly 20 years old. She recommended
combining those numbers with local intelligence.
Council members suggested that the Special
Populations website should include a link
to all of the COGs. Capt. Lopez agreed
that this would be important and promised
to look into this.
- ACTION ITEM:
Capt. Lopez will look into the possibility
of adding links to all of the COGs on
the Special Populations website.
Dr. Fernandez thanked Ms. Ryder for her
presentation and opened the floor for
discussion.
Council Discussion
Dr. Fernandez asked if the Council wished
to prepare a letter to the Secretary based
on the cross-cutting issues that arose
in the Subcommittee reports, which were:
- Need to increase access to and utilization
of services (e.g., by expanding capacity,
ensuring portability of benefits, and
addressing fears about documentation
requirements)
- Need to obtain accurate, updated data
to justify need for funding and direct
resources appropriately (e.g., number
of MSFWs, gender breakdown, locations,
migration patterns, utilization rate)
Dr. Fernandez noted that the tools described
by Ms. Ryder could be utilized to obtain
updated data. He suggested that the Council
invite Alice Larson to make a presentation
at a future meeting.
Ms. Canales stated that portable health
insurance would help with data collection.
Ms. Ryder stated that it would not be
necessary to wait for national health
insurance. She suggested that a national
registration system for the migrant health
program would eliminate the need for farmworkers
to reverify their status each year. Some
Council members expressed concern that
farmworkers would be reluctant to register
for a system that would assign them an
identification number. Ms. Ryder noted
that any new system should be piloted
first. She suggested that if the Council
chose to draft a recommendation in this
area, it should be linked to previous
recommendations regarding portability
and continuity of care.
Dr. McFarland suggested linking the recommendation
on portability to the oral health benefit
for Migrant Head Start. Dr Gomez informed
Council members that this was a small
pilot project that was conducted to determine
the feasibility of the model presented
in the CMS portability study. Dr. Weathers
requested information on this, and Dr.
McFarland offered to send her a copy.
- ACTION ITEM:
Dr. McFarland will send information
regarding the pilot project on oral
health benefits for Migrant Head Start
to Dr. Weathers.
Dr. Weathers suggested that the Council
write a letter to discuss the need for
updated data and increased access to services.
Council members discussed whether to prepare
a rough draft at this meeting. Dr. Weathers
noted that the Council had just identified
these issues and would benefit from having
some time to consider them. She suggested
that the Council schedule a conference
call prior to the November meeting to
discuss these issues. Dr. Gomez stated
that she could assist with arrangements
for the call.
Dr. McFarland stated that his greatest
frustration during his term on the Council
was the inability to increase the capacity
of the program to serve a greater number
of MSFWs and their families. He stated
that the key issues for the letter and
recommendations were increased access,
and increased capacity. Dr. Fernandez
suggested that Medicaid portability might
be a third issue.
Dr. Gomez asked the Council to let her
know what information they would need
to prepare their letter. She offered to
provide Council members with a copy of
the Secretary’s report to Congress on
the CMS portability study and the recommendations
of the expert group. She also recommended
that Council members review the enumeration
data on the NCFH website; NAWS data; UDS
data on the HRSA website; and the websites
of other COGs. She promised to provide
the Council with the URLs for these websites.
- ACTION ITEM:
Dr. Gomez will assist the Council in
scheduling a conference call to discuss
its next letter to the Secretary.
- ACTION ITEM:
Dr. Gomez will provide Council members
with a copy of the Secretary’s report
on the CMS portability study and the
recommendations of the expert group
convened by BPHC.
- ACTION ITEM:
Dr. Gomez will provide Council members
with website addresses for the NCFH,
NAWS, UDS data, and the COGs.
Ms. Ryder noted that the expert workgroup
was convened at the outset of the CMS
study. She suggested that the Council
ask the Secretary to reconvene the workgroup
to analyze the results of the study and
identify aspects that could be implemented.
Dr. Gomez noted that the Council could
recommend a wide range of actions, from
those that can be addressed at the HRSA
level to those that require action by
the Secretary or Congress.
Mr. DuRussel noted that the Council had
addressed portability in its letter of
November 2007, along with many other issues.
The last letter emphasized outreach. He
felt it was important to be concise and
focused and that the Council should not
duplicate an earlier message. Dr. Weather
suggested that it would be appropriate
to remind the Secretary of previous recommendations.
Ms. Castillo suggested that this could
be a way to acknowledge progress that
the Council has seen in response to its
recommendations.
Dr. Fernandez turned the floor over to
Donald Weaver.
Dialogue with Council Members
- Donald Weaver, M.D., Deputy Associate
Administrator for Primary Health Care
Dr. Weaver extended greetings to the
Council on behalf of Dr. Duke and Jim
Macrae. He emphasized that Capt. Lopez,
Dr. Gomez, and Ms. Cate were three of
the best advocates for migrant health.
Dr. Weaver stated that the Council’s
recommendations had assisted HRSA in its
efforts to increase access and reduce
disparities. He noted that the Council
brought new meaning to the expression,
“Si, se puede.”
Dr. Weaver noted that PINs were now listed
by subject matter, rather than by number.
This change was made to make it easier
to find information. Dr. Weaver emphasized
that HRSA was committed to transparency
and openness and would not convene special
groups to obtain consensus opinions. Dr.
Weaver stressed the importance of the
comment periods and urged Council members
to comment on PINs as individuals or as
a group.
Dr. Weaver stated that HRSA has three
important roles: compliance; working with
grantees to improve their performance;
and primary health care leadership to
demonstrate what works. He noted that
HRSA provides a health home –and not just
a medical home—for those it is privileged
to serve.
Dr. Weaver noted that sharing stories
that work helps to illustrate the reality
behind the numbers. He urged Council members
to continue to share these stories, and
not to limit them to formal letters.
Dr. Weaver thanked the Council again
for its work and its commitment to improving
the migrant health program.
November Meeting Agenda Items
The Council agreed that the tentative
dates for the next meeting would be November
17-18, 2008. The meeting would take place
in New Orleans, LA, in conjunction with
the Midwest Stream Farmworker Health Forum.
The Council agreed that the agenda should
include farmworker testimonies. Alice
Larson, Migrant Clinicians’ Network, and
Migrant Health Promotion should be invited
to make presentations.
Logistical Information
Gladys Cate reviewed the documents to
return to OMSP. She urged Council members
to submit their expense reports as soon
as possible so that reimbursements could
be processed in a timely manner.
Ms. Canales moved to adjourn. The motion
was seconded by Ms. Castro and carried
unanimously. The Chair adjourned the meeting
at 4:30 p.m.
ACTION ITEMS
- NACHC will ask experts in the areas
of outreach and guestworker rules to
assist the Council in making recommendations
in these areas by providing background
information and proposed language.
- Capt. Lopez will look into the possibility
of adding links to all of the COGs on
the Special Populations website.
- Dr. McFarland will send information
regarding the pilot project on oral
health benefits for Migrant Head Start
to Dr. Weathers.
- Dr. Gomez will provide Council members
with a copy of the Secretary’s report
on the CMS portability study and the
recommendations of the expert group
convened by BPHC.
- Dr. Gomez will provide Council members
with website addresses for the NCFH,
NAWS, UDS data, and each of the COGs.
- Dr. Gomez will assist the Council
in scheduling a conference call to discuss
its next letter to the Secretary.
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