Vegetable Bins Make Great Desks: Using Unconventional Methods to Enroll Migrant Farmworkers in Health Coverage

By Guest Blogger

This guest post was written by Jan Morrill from the Maine Migrant Health Program.

Outreach and enrollment with migrant seasonal farmworkers (MSFWs) can be especially challenging for assisters. More often than not, MSFWs work long hours, aren’t familiar with their opportunities and responsibilities under the Affordable Care Act (ACA), don’t speak English, or don’t know who is available to help them enroll in health insurance. In order to ensure success, assisters need to adapt their outreach and enrollment strategies.

As an organization with over 20 years of experience working with MSFWs, assisters at the Maine Migrant Health Program (MMHP) have focused their efforts on flexibility and mobility to make sure they are available to meet MSFWs’ needs. All MMHP assisters’ tools are completely mobile, and often assisters enroll clients at farmworker campsites after hours or on weekends. MMHP targets outreach both towards workers themselves and their employers with culturally and linguistically appropriate materials. Assisters understand that working with farmworker populations requires an added level of commitment and availability to follow up with complicated cases, and expect to meet with clients on multiple occasions.

MMHP had the opportunity to enroll workers with temporary agricultural work authorization (H2A visas) at a fruit and vegetable farm in the rural town of Warren for two years in a row. Most of the workers arrive at the farm between May and July and return to Jamaica in November. The majority of the workers qualify for cost-sharing reductions and premium tax credits that allow them to choose plans for under $10 a month. In order to successfully enroll clients, assisters turn vegetable bins into desks, connect computers to Wi-Fi hotspots, and use their cellphones to complete the applications. Appointments start at 4:00 p.m. and continue into the evening, sometimes as late as 8:00 or 9:00 p.m. To date, MMHP has been able to enroll all the interested workers at that farm site.


MMHP has developed specialized expertise enrolling H-2A workers. H-2A workers usually haven’t heard much about the ACA or the requirement to have health insurance, and because they are typically only in the U.S. for a short time there is a very small window for assisters to connect with them. And, their specialized immigration status makes the enrollment process more complicated than the average consumer. To overcome some of these challenges, MMHP recommends:

  • Following H-2A workers’ arrival in the state by monitoring the Department of Labor’s website
  • Training community health workers and outreach workers to spread information about the ACA
  • Using federal resources to obtain specialized immigration information required by the marketplace
  • Having a process to troubleshoot problems as they arise during enrollment

For more detailed information about enrolling H-2A workers, see these resources:

Contact Jan Morrill at the Maine Migrant Health Program [] with questions about MMHP’s program or for more information.

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