Program
In order to assist migrant families to maintain their health coverage and access health care services while traveling out-of-state, an approach has been conceived that has substantial precedent in law, and is operationally possible. The Texas Migrant Care Network (TMCN), which is a joint collaborative between TACHC and the state's Medicaid agency (Health & Human Services Commission or HHSC) includes enrolling out-of-state clinicians and Federally Qualified Health Center (FQHC) providers in the Texas Medicaid Program to build a network that provides Texas migrant families with access to preventative care, primary care, specialty care, hospitals, dental services, mental health services and pharmacy services while they travel out of state for work. To see TACHC's policy paper that explains the model of the program click here.
The TMCN was launched during the 2008 migrant season and has successfully paid almost 500 claims to different providers in Illinois, Minnesota, Michigan, Ohio, and Washington. Click here for the most current list of enrolled out-of-state Texas Medicaid providers. Since the program's inception, TACHC has launched an outreach campaign to inform migrant families before they leave Texas about the TMCN and are provided with information to keep their Texas Medicaid active. These outreach materials also provide a toll-free number to help migrant families locate providers who are enrolled in Texas Medicaid. The TMCN saves considerable money by assuring that migrant children and pregnant women are provided services while traveling out-of-state with their families. It prevents migrant families from experiencing gaps in their coverage and helps encourage better health outcomes for this vulnerable population. It also should be noted that Texas Medicaid has agreed to pay sister FQHCs in other states their Prospective Payment System or PPS encounter rate. This is a win-win for both the families and the caring providers who provide their health care.
The TMCN is not an expansion of benefits or expanded eligibility under Texas Medicaid. It only provides a mechanism to help migrant families maintain their existing health insurance coverage while they are traveling out-of-state for agricultural or other seasonal employment. To participate in the program, Texas migrant families and their children need only be enrolled in Texas Medicaid before they leave the state and seek services with an out-of-state Texas Medicaid provider.
It will take more than outreach activities and the establishment of a network of providers to make this a complete success. A major challenge includes the initial enrollment into Texas Medicaid and recertification at the end of the child's six months of eligibility if it occurs while the family is traveling outside of Texas. Currently, there is a policy in place to try and capture the migrant children to ensure they renew or have the proper documents for recertification before they leave, but some migrant families still fall between the cracks due to their high mobility. TACHC continues to advocate for continuous eligibility provisions at the state level with state policy makers and encourage innovative improvement to the re-enrollment procedures for this population. Furthermore, targeted outreach is being done for the migrant population to let them know that it is not futile to enroll or maintain their Texas Medicaid coverage any longer because they will be able to see a provider while they are out-of-state. Another challenge is that in our experience with this population, migrant families are often fearful or suspicious of governmental entities as evidenced by the lack of response the state has experienced in requesting that migrant families self-identify on the joint Medicaid and CHIP applications. Migrant families are much more likely to accept information and respond to organizations and groups that they deal with frequently such as schools, churches, promotoras/es and Federally Qualified Health Centers (FQHC). Any outreach campaign targeting migrant children should utilize this existing support network to help promote and enroll children into Medicaid and CHIP and encourage parents to self-declare on the Medicaid application if they are migrant families.
Just like the regular Medicaid enrollees, this population also needs to be educated about proper utilization of health care and the importance of preventative and regular primary health care services. The aforementioned groups, in particular schools and FQHCs, can be used to promote and coordinate the use of preventative health care services available under Medicaid. For more information on resources to educate families and to help bring awareness of the TMCN to families, please visit the resources page of this section.
The TMCN would alleviate many of the barriers that these families face. By establishing a comprehensive network of health care providers and offering intensive outreach, transportation and health education services, migrant families will be able to access health care services while in state and out-of-state.
