Patients who receive care at migrant health centers located in Medicaid expansion states are increasingly likely to have Medicaid, according to a report published today by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University (GW). The researchers examined national survey data on the nation's agricultural workers and analyzed data from community health centers, including trends over time in insurance coverage of patients at health centers that specialize in caring for agricultural workers and their families.
The report documents the major role played by health centers that receive migrant health funding in providing health care services to agricultural workers. In 2014, the nation's community health centers served nearly 892,000 agricultural workers and their families. Migrant health centers accounted for 91 percent of all agricultural workers and families served by health centers that year.
As with the national agricultural population, the agricultural health center patient population is clustered in California, the Pacific Northwest, and the South. Health centers in just four states (California, Florida, North Carolina, and Washington) accounted for 71 percent of all agricultural patients served by health centers in 2014.
According to national survey data, agricultural workers and their families remain much more likely than other low-income populations to be uninsured - 66 percent versus 32 percent of low-income adults generally. While data on community health centers does not specifically report insurance coverage of agricultural workers and their families, insurance coverage of migrant health center patients has increased over time; between 2003 and 2014, the proportion of uninsured patients served by health centers receiving migrant funding dropped from 42 percent to 30 percent, and state Medicaid expansion has played the major role in this trend. Although migrant health centers in both Medicaid expansion and non-expansion states had statistically significant declines in their uninsured rates between 2013 and 2014, when the ACA was fully implemented, the decline was steeper in Medicaid expansion states. Over the 2013-2014 time period, migrant health centers in Medicaid expansion states registered a statistically significant increase in the percentage of patients with Medicaid coverage, while migrant health centers in non-expansion states did not.
According to the study, three factors might account for the impact of the Medicaid expansion on migrant health centers and their patients: (1) high poverty among agricultural workers; (2) the growing tendency among agricultural workers to settle and work in one state rather than migrating across state lines, which in turn may increase the likelihood that they will qualify for Medicaid in their state of residence; and (3) rising Medicaid coverage rates among non-farmworker patients served by health centers that receive migrant funding.
The findings from this study underscore the importance of Medicaid expansion in states whose large agricultural industry offers only limited employer coverage. Between 2013 and 2014, migrant health centers in California and Washington - both states that have expanded Medicaid - the percentage of uninsured patients dropped by 9 and 11 percentage points, respectively. Yet migrant health centers located in Florida and North Carolina - both non-expansion states - showed a decline in the proportion of uninsured patients of only 3 to 4 percentage points.
Without Medicaid expansion, health centers serving agricultural workers - a population with especially significant health needs - may encounter additional difficulties providing comprehensive primary care and expanding dental and mental health service capacity for their patients when needed, the authors note.
"There are up to 3 million migrant and seasonal agricultural workers who provide essential labor on farms and ranches in the United States," says author Peter Shin, PhD, MPH, Associate Professor of Health Policy and Management at Milken Institute SPH. "This report shows that Medicaid is reaching the populations served even by those health centers providing care to patients most likely to be uninsured."
"We still face many challenges to providing care for agricultural workers, especially in states that have not expanded Medicaid," says Feygele Jacobs, President and CEO of the RCHN Community Health Foundation, which funded the report. "Community health centers will continue to need stable grant funding in order to expand into isolated areas and provide specialized services to this at-risk population."
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