Policy Options and Alternatives of the Migrant Health Problem Though immigrants and families experience the very same health issues as the rest of the population, many factors such as: poverty, migrancy, occupational hazards, inferior living conditions, and cultural and linguistic barriers faced by these individuals lead to development of unique health issues. As a consequence, the average migrant life expectancy is 49 years, a low figure compared to the country average (75 years) (Cunningham, 2006).

Description of existing policy gaps

There are several barriers to receiving Medicaid coverage that are faced by migrants. While some issues impact low-income groups in general, several issues are inflamed by migrant characteristics, such as their unstable incomes, migratory patterns and immigrant status.

Many migrants aren't entitled to receive Medicaid coverage. One of the significant obstacles is that states, under the existing law, cannot provide low-income, non-disabled adults, who don't have any dependent children, with Medicaid coverage. Moreover, immigrants since 1996 (even legal immigrants) aren't entitled to Medicaid during the first 5 years of their residing in the U.S. Some states, from a standpoint of financial eligibility, employ monthly budgeting policies and restrictive asset measures, making entitlement difficult for those with low, unstable incomes and basic assets required for employment, such as a truck (Rosenbaum & Shin, 2005).

Migrants who are eligible may face enrollment difficulties. Medicaid-eligible migrants may encounter difficulties in applying and enrolling in Medicaid. Because of their poor English-language skills, completing long forms or meeting broad verification conditions may prove difficult, especially in case of limited access to language assistance. Enrollment may also be hindered by unreachability of sites (Cunningham, 2006).

Migrants encounter state residency obstacles to coverage, due to repeated shifting between states in search of a living. The Medicaid insurance program is state-based. This program makes use of state residency for those who reside, to earn a living, in some particular U.S. state, in order to confer eligibility. States also have to offer inter-state coverage to residents while they travel; however, this coverage is rather limited. Consequently, migrant workers may try to enroll in Medicaid every time they shift from one state to another, but may come across the aforementioned enrollment barriers. Then again, workers may travel, from a state of permanent residency, and use their Medicaid card in other states, but may learn that coverage is only provided for emergency cases. These individuals may also encounter difficulties in locating a provider, from another state, who may be ready to honor their card (Hansen & Donohoe, 2003).

Three policy options to the gaps

Some states (such as Texas and Wisconsin) have, in the past few years, tried to better Medicaid service to migrants. Looking at these states, it has been revealed that that Medicaid may become more accessible by means of speedy enrollment, reachable enrollment sites, acceptance of enrollment cards from other states, and coverage of numerous out-of-state services. Federal authorities may play a role in improving the willingness of states to take up these ideas and improve efficiency (Cunningham, 2006). Federal authorities could also work at extensive efforts for addressing the coverage obstacles faced by migrant workers:

1. Improving Medicaid access. Several actions may be undertaken to ease enrollment of migrant workers in Medicaid, and their utilization of Medicaid coverage.

Enabling reciprocity of eligibility among states. Acceptance of inter-state enrollment cards may work effectively; however, this option is impeded by different eligibility standards in different states. Federal guidelines can facilitate this, through implementation of speedy enrollment, modifying existing eligibility conditions, and picking out health facilities and programs to serve as enrollment centers. Reciprocity can be encouraged further by permitting states to form separate eligibility criteria for migrants and migrant-families, which may be uniform across all states in the nation (California Primary Care Association, 2002; Cunningham, 2006).

Furthering the traveling-Medicaid card initiative. Reimbursing out-of-state Medicaid services necessitates efforts for identifying out-of-state health providers who are ready to cooperate and participate, as well as a claims administrative intermediary. Government efforts could boost and advance the model. For instance, establishing a regional intermediate body could enable out-of-state claims processing, formation of a network of healthcare providers, and education and outreach for traveling migrant families. The initiative's costs would seem to be linked directly to the state Medicaid organization and, therefore, qualified for settlement (Hansen & Donohoe, 2003; California Primary Care Association, 2002).

2. Creation of a new national coverage initiative for migrants and families.

While the aforementioned initiatives may facilitate enrollment and reach among entitled migrants, they won't be capable of overcoming the barriers that arise out of Medicaid's principle of excluding recent immigrants and adults with no dependent children. A better solution to migrants' problems would be combining...

Migrants' health needs are substantial; however they constitute a relatively small share of the nation's population. The evidence examined in different research (California Primary Care Association, 2002) indicates the significance of meeting immigrant needs and offers numerous practicable options, including endeavors by Medicaid in collaboration with other health programs to enhance Medicaid's reach. These efforts may help overcome the key challenges faced by migrants and migrant-families in obtaining health insurance and much-needed health care (Hansen & Donohoe, 2003).
3. Advocacy and policy development

Advocating health policies that are migrant-sensitive, conform to community health approach principles, and aim to improve migrant health is an important goal. Advocacy should also: promote migrant health rights; support equitable health care and coverage access for migrants; formulate mechanisms for enhancing social security in safety and health for migrants; promote global cooperation on, and awareness of, health of migrants in their countries of return/origin, destination and transit; nurture collaboration between foreign affairs, health, and other relevant departments in all involved nations; reinforce inter-institutional, inter-regional and global cooperation with regard to migrant health. Advocacy should also focus on forging partnerships with International Organization for Migration, United Nations High Commissioner for Refugees (UNHCR) and other organizations. As well, it should foster cooperation among civil society representatives, local and central authorities, towards health policies (Hansen & Donohoe, 2003).

Option chosen

The last option, advocacy and policy development proves as the best route to solving migrant health-related issues. Migrants and families are central to America's economy and diversity, and yet are an under-served and marginalized population, having several unmet healthcare and socioeconomic needs (Hansen & Donohoe, 2003). Poverty, migrancy, occupational hazards, inferior living conditions, and cultural and linguistic barriers play a role in migrant health issues; they form the barriers to migrant healthcare. The challenge for policymakers, health providers, and socially-conscious U.S. citizens is to create a more powerful public health advocacy and policy. As well, it is important to collect more information on migrant-specific health problems; to improve provider and migrant education; and to increase awareness of migrant issues that are problematic (Rosenbaum & Shin, 2005). These people who contribute to America's growth and progress are deserving of much more than they currently get.

In view of the fairly low health insurance rates among legal and undocumented migrants, policies are required to expand health insurance, community health centers, and other healthcare facility access. Policies may also attempt to increase employer-sponsored migrant health insurance. These are especially relevant, as migrants are a lot less likely, compared to their American-born colleagues, to obtain such health insurance. Policies may include employer directives that assure affordable insurance to employees, in addition to educating eligible individuals regarding insurance's value (California Primary Care Association, 2002).

Pros and cons of the advocacy and policy development option

Pros

Health policies for migrants acknowledge migrant rights to be accorded access to safety and health. Migrant patients enjoy unprecedented sickness-treatment and availability of facilities for speedy recovery, within nations that have fiscal and economic growth stability. This subsequently stems from the basic idea of preference to health "security," i.e. whether they can rely on community health organizations to provide them with the required treatment to cure, or at least purge them of, impending illness (Cunningham, 2006).

A centralized migrant healthcare advocacy and policy denotes budgetary allocations are equitably made without considering likely investment options for medical improvements. While this ensures budget security to hospitals, they can't wholly depend on their constraints to fully serve patients (Cunningham, 2006).

Providing migrants with insurance benefits is pivotal to the migrant health strategy issue. On a social note, the above benefit may actually denote a net positive benefit to health economy. A majority of registered taxpayers with ample money prefer utilizing the services of private health institutions, under the assumption that they offer more speedy treatment. Hence, hospitals can easily cater to persons who pay much lower taxes than hospital fees (Cunningham, 2006).

Cons

Regulations regarding service eligibility for different immigrant categories are extremely complex and generally misunderstood by both providers and patients. Steps must be taken to ensure that clients aren't reluctant to access care due to a fear of violation of security and confidentiality, and aren't denied the services they are entitled to (California Primary Care Association, 2002).

Extra support is needed to dispel elected officials' and native-citizens' beliefs regarding migrants. Xenophobia…