Medicaid and Migrant Farmworkers: Why the State Residency Requirement Presents a Significant Access Barrier and What States Should Do About It.

Abstract

Medicaid is failing to meet the health needs of qualified migrant farmworkers because of their migratory lifestyle. This population moves frequently, following various agricultural harvests, and the state residency requirements imposed by Medicaid create a significant access barrier that most migrant farmworkers cannot overcome. Migrant farmworkers are unable to overcome the state residency requirement for several reasons: language and cultural barriers, the difficulty in applying, and statutory impediments such as the five-year ban and the proof-of-citizenship requirement. Several states have attempted to integrate migrant farmworkers into both their state-run Medicaid and general public health systems with varying degrees of success. Both Texas and Wisconsin have implemented creative solutions to this Medicaid coverage problem and these existing models will be examined for both strengths and weaknesses. Finally, after assessing whether the Equal Protection Clause of the Fourteenth Amendment requires that a state provide U.S. citizen migrant farmworkers with access to Medicaid despite their transient lifestyles, I will propose three possible solutions to the problem—the ACA Medicaid Expansion, a hybrid Wisconsin/Texas model, and individualized solutions tailored to each state.