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					Health and Human Services Commission

FREW Medical and Dental Initiatives
Proposal Migrant System Interfaces Proposal

According to a study by the US Department of Health and Human Services (DHHS), the health problems facing migrant children are infectious disease, perceived health status, incidence of acute conditions and pesticide exposure on a national level. The same study identifies the challenges to accessing care for children of migrant farm workers are poverty, lack of insurance, social/environmental factors, immigration status and geographic isolation.i The Texas Education Agency (TEA) in collaboration with 225 of 500 school districts statewide having migrant programs have identified higher proportions of dental, nutritional, acute, and chronic health problems than non-migrant children.ii. Through collaborative efforts between the school districts and TEA, school staff is able to coordinate access to dental and vision services if those services are not provided to migrant students otherwise. An obstacle that faces HHSC in assessing the health care needs of migrant families is the dated health care information available on migrants in Texas. For instance, the DHHS study was done in 1997. An enumeration study prepared by the Health Resources and Service Administration (HRSA) that offers Texas migrant farm workers information at the county level also used by HHSC currently was Background: completed in 2000iii As HHSC has mandated its contractors such as the health maintenance organizations (HMOs) and Texas Medicaid & Healthcare Partnership (TMHP) and Primary Care Case Management (PCCM) in providing migrant children TH Steps checkups, immunizations, accelerated services, HHSC has received feedback from contractors about the challenges of providing “targeted” services to children that are not easily identified in any of their systems or HHSC systems. TEA through its Management Information Systems (MIS) captures children of migrant farm worker information from three to twenty one years of age. While many three to five year olds are not enrolled in school, the information is reported to TEA during school registration of migrant children in a household. Furthermore, HMOs and PCCM are required to maintain accurate lists of children of migrant farm workers enrolled within their health plan through validation by telephonic and correspondence contact with the migrant families. At the present time, there is no mechanism in place for the exchange of migrant children data back to HHSC between TEA, HMOs and PCCM HHSC will develop a file exchange process where TEA will provide a data file of Description of children enrolled in their Migrant Education Program to HHSC at a set interval. Proposal: HHSC’s MIS will run a comparison of the file from TEA with the Medicaid eligibility file to identify children of migrant workers who receive Medicaid. This
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Health and Human Services Commission

FREW Medical and Dental Initiatives
Proposal Migrant System Interfaces Proposal

information will allow HHSC as well as contracted providers, such as HMOs and PCCM to develop data specific outreach plans that complements the needs of migrant children enrolled in Medicaid and develop plans to improve their access to health care services and providers in Medicaid. In addition to the process to match children receiving services from TEA and Medicaid, HHSC will analyze the need to establish an electronic process to update eligibility files for children of migrant workers identified by managed care organizations. The analysis will include a comparison of children matched with TEA and Medicaid eligibility with a list of all children identified by Medicaid managed care organizations. HHSC will determine whether an electronic process or manual process will be used to update files for children identified by managed care organizations who are not identified by TEA. HHSC and PCCM have been working with Medicaid managed care contractors on the development and approval of children of migrant farm worker plans for state fiscal year 2008. Some examples of initiatives that are being utilized by Medicaid managed care include:     Current Texas Medicaid Policy:   Placing materials for migrant workers in new member packets asking families to contact the HMO if the member with that HMO is a migrant. Completion of a health assessment including questions about being a migrant and migration plans. Training Primary Care Providers about the accelerated TH Steps medical check ups for children of migrant farm workers. Tracking migration patterns for members and reaching out to members to coordinate health care services before and after transition. Providing service coordination for migrant families during transition. Providing migrant families with “travel packets” that contain information on the child’s health history.

HHSC along with community partners is working to better inform applicants on the importance of identification of migrant status. In November, HHSC staff from the Office of Family Services and Medicaid/CHIP Division presented to participants at the Texas Education Agencies Migrant Educators Conference about the importance of identifying migrant status on applications. A policy clarification was provided via THMP banner message in the 2008 Texas Medicaid Provider Procedures Manual stating that a migrant child could receive an accelerated checkup before the family leaves the area and checkups would be filled as exception to periodicity. The Office of Family Services (OFS) updated the migrant farm worker question on the eligibility application to include language stating the intent is to identify
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Health and Human Services Commission

FREW Medical and Dental Initiatives
Proposal Migrant System Interfaces Proposal

migrant children so that their health care needs could be managed more efficiently.

HHSC Enterprise Applications will develop these interfaces with the technology and program staff at TEA and contracted staff. Resources to be funded include additional staff or contracted time to develop a system that can read each agency’s information in an understandable, electronic format. Total cost for system interfaces with TEA and HHSC contractors: $283,360 for both federal and state funds. Assumes 50% match.

Fiscal Assumptions and SFY 2009: $130,980 GR ($261,960 AF) Impact: TEA Migrant Education Program: $10,000 HHSC Information Technology: $120,760 HHSC Enterprise Applications: $131,200 SFY 2010: $10,700 GR ($21,400 AF) TEA Migrant Education Program: $1,000 HHSC Information Technology: $15,600 HHSC Enterprise Application: $4,800

HHSC was unable to obtain feedback from how other states were able to structure specific programs for migrant and data issues they encountered. Below are health care delivery improvements for migrants in other statesiv:  Reciprocity agreements between states to serve children enrolled in Medicaid. Such agreements are with two or more states that agree to recognize each other’s Medicaid eligibility determinations in providing services to migrant workers. Unilateral action to serve all farm workers. Wisconsin serves any migrant worker with a Medicaid card from any state. Special arrangements for reimbursement for out-of-state providers. A state makes arrangements with out-of-state providers such as clinics or physicians to provide services to the first state’s beneficiaries.

Other States:

 

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Health and Human Services Commission

FREW Medical and Dental Initiatives
Proposal Migrant System Interfaces Proposal

Advantages: TEA/HHSC file exchange  The identification of school aged children who are migrant farm workers.  The ability to use the information received from the file exchange for outreach purposes by the HMOs and PCCM.  Outreach efforts to migrants would result in a great number of children receiving TH Steps checkups, immunizations and accelerated services. Disadvantages:  TEA does not capture the Medicaid number and Social Security information on children of migrant farm workers.  Matching the children on the file from TEA and the Medicaid file would only include a match of name, address and date of birth, head of household creating higher risk in the matching process.  It is unknown how accurate the data from TEA is being exchanged in the file to HHSC.  May require seeking advisory opinions from the US Department of Education’s Family Policy Office and/or Texas Attorney General’s Office.  Require updating TEA Family Educational Rights and Privacy Act (FERPA) notification documents which could take several months. Advantages: HMO’s/HHSC file exchange    The identification of children of migrant farm workers by HMOs and PCCM. Process would help to validate HMO and PCCM requirement to maintain accurate lists of children of migrant farm workers. Process will help to validate that HMOs are contacting Migrant families.

Application to Texas – Advantages & Disadvantages to Funding this Proposal:

Disadvantages: None
Increase the number of children who receive THSteps medical and dental checkup Increase participation of medical and dental providers who serve children in the Texas Medicaid Program Improve Appropriate Utilization of Medically Necessary Services

Meets FREW related Objective

X

x

Improve Coordination of Care

X

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Health and Human Services Commission

FREW Medical and Dental Initiatives
Proposal Migrant System Interfaces Proposal

Stand Alone Option

X

This Option should be considered in conjunction with other FREW Strategic Initiatives

Due to the Family Educational Rights and Privacy Act (FERPA), TEA is able to Other release information on migrant children to HHSC, but HHSC cannot release the Considerations information to the HMOs and PCCM without prior consent of the parents. See additional information below about a request for information (RFI) seeking stakeholder feedback on ideas to improve access to health care services and providers to migrant children enrolled in Medicaid. State and Federal Approval(s) Required:
1115 Waiver Rules

Federal

Other Waiver(s), State Plan Amendment

State

Legislation

Affected Stakeholders  Health and Human Services Commission, Department of State Health Services, Texas Education Agency, Enrollment Broker, Managed Care Organizations, PCCM, Migrant organizations, Children of migrant farm workers

Systems & Resource Considerations  TEA and HHSC information technology staff have to agree on a way to make their systems interoperable and to confirm that information is protected as it is transferring from one government entity to another.

Implementation Considerations & Other Considerations Timeframes: HHSC is developing a Request for Information (RFI) so that stakeholders who have experience working with Migrants can provide the agency with an understanding of this population, such as their historical health care needs and utilization patterns, how they access health care services, how providers can best provide health care to them, what are their outstanding health care needs, and what system improvements they would recommend to improve overall access to care for these migrant children. The information that HHSC gains from this RFI could be shared with managed care organizations working with migrant families in providing TH steps checkups/immunizations, providing accelerated services to migrant children and to provide acute care services. The areas that the RFI would target would include: an understanding of where migrant families in Texas reside, migration patterns and destinations, migration timeliness for families, identifying challenges migrant children may face in accessing Medicaid services, provide a better understanding of the health care needs of migrant children, the best ways to
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Health and Human Services Commission

FREW Medical and Dental Initiatives
Proposal Migrant System Interfaces Proposal

communicate with migrant families and health related information that migrant families can use while in state and can take with them during their migration. Implementation Timeframes (in months)  About seven months from June 2008.

HHSC Interagency The interagency workgroup provided unanimous support for this proposal and Workgroup recommended that staff proceed cautiously with the TEA data to make sure there is Recommendation: enough information to link TEA and HHSC data. FREW Technical The Frew Committee provided unanimous support for this proposal. Committee Advisory members requested that HHSC be mindful of health privacy issues with this Committee population. Recommendation:

i

“The Children’s Health Initiative and Migrant and Seasonal Farm worker Children,” US Department of Health and Human Services, October 24, 1997.
ii.

Request for Proposal “Evaluation of the Texas Migrant Education Program.” Texas Education Agency, RFP No. 701-08039 iii “Migrant and Seasonal Farm worker Enumeration Profiles Study, Texas” Migrant Health Program, Bureau of Primary Health, Health Resources and Services Administration. September 2000 iv “Policy Options for Serving Children and Families Under Medicaid and SCHIP” June 2000

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