Document Type

Journal Article

Publication Date



George Washington University Milken Institute School of Public Health Geiger Gibson/RCHN Community Health Foundation Research Collaborative


Policy Research Brief # 44


Migratory and seasonal agricultural workers (MSAWs) provide essential labor for farming in all its branches in the United States. Between 2.4 and 3 million MSAWs live across the U.S. in every state but are clustered in areas dense with agricultural employment. As a population already susceptible to poor health outcomes because of poverty and work-related health risks, MSAWs depend on community health centers, especially those known as migrant health centers that receive additional migrant funding. Reporting data from a national survey of agricultural workers, as well as findings from analyses of data from the Uniform Data System (UDS) that covers all health centers, this analysis finds that:

  • In 2014, health centers served approximately 892,000 migrant and seasonal agricultural workers and their dependents.
  • Migrant and seasonal agricultural workers rely particularly on health centers that receive additional migrant funding (migrant health centers). In 2014, migrant health centers accounted for 9 in 10 agricultural worker patients served by federally-funded health centers nationally.
  • Medicaid expansion appears to play a key role in expanding health insurance coverage at migrant health centers. Although migrant health centers in both Medicaid expansion and non-expansion states experienced significant decreases in their uninsured rates between 2013 and 2014, the decline was steeper in Medicaid expansion states. Migrant health centers in Medicaid expansion states also registered a statistically significant increase in the percentage of patients with Medicaid coverage between 2013 and 2014, while migrant health centers in nonexpansion states did not.
  • A closer, focused examination of 16 migrant health centers with the highest percentage of agricultural worker patients found that those served by migrant health centers located in Medicaid-non-expansion states were twice as likely to be uninsured in 2014 as those served by migrant health centers located in expansion states.

These findings suggest that the Medicaid expansion matters even to safety net clinics serving heavily uninsured populations. Medicaid may be reaching additional agricultural workers not only because of their deep poverty but also their growing tendency to work in the state in which they reside, thereby reducing the risk that they will lose Medicaid coverage when they move to another state temporarily for work reasons. At the same time, these findings also underscore the special importance of grant funding, given the high rates at which agricultural workers lack health insurance coverage.

Peer Reviewed


Open Access