Problems in the Structure and Management of the Migrant Health Program

GAO reviewed the design of the migrant health care delivery system and discussed alternatives in response to congressional concern about the appropriateness of combining migrant funds with funds for the medically underserved under the Community Health Center (CHC) program to operate integrated centers. Because of these concerns, GAO examined the reasons for the integrated operations and the impact of combined funding.

GAO considered three alternatives for consolidating programs for migrants, seasonal farmworkers, and the medically underserved including: (1) eliminating seasonal farmworkers from the Migrant Health program and incorporating them into the CHC program; (2) discontinuing the use of Migrant Health program funds at consolidated centers and serving all eligible users of CHC's with CHC funds, and use Migrant Health program funds in those areas without CHC's or for special access-to-care problems which migrants face, such as access to in-hospital care; and (3) consolidating the Migrant Health program and the CHC program. All of these options have the advantage of eliminating unnecessary program distinctions among migrants, seasonal farmworkers, and the medically underserved with similar health needs. They also avoid the problems caused by trying to manage separate programs within individual centers. One drawback is that, without a separate funding source, migrants and seasonal farmworkers may lose their leverage for obtaining services at integrated centers. Participation by farmworkers or persons representing migrant interests on governing boards is one way to help assure that the migrants' concerns are considered. A drawback of the first option is that joint funding would continue although the farmworker group to be served would be limited to migrants. Under the third option migrants could lose some unique benefits, such as hospitalization and sanitation programs. A health grant block to States could allow States to shift funds currently benefiting migrants to other populations.