Mara Youdelman, Jane Perkins, Jamie D. Brooks, Deborah Reid
For over 40 years, civil rights laws have prohibited federally funded entities from discriminating on the basis of national origin, race, and ethnicity. Changing demographics, however, as well as heightened federal and state policies, have increased the need for effective and efficient models of providing language services to individuals who are limited English proficient (LEP).
Medicaid and the State Children's Health Insurance Program (SCHIP) provide health insurance to many low-income individuals, including those who are LEP. State and local benefits offices ("benefits offices") that administer these programs are responsible for activities such as outreach, enrollment, retention, and communication with applicants/enrollees ("clients"). These benefits offices must be able to communicate effectively with their LEP clients. Communication can, in fact, be the deciding factor in whether a LEP individual actually enrolls in a program and receives benefits. Benefits offices that have implemented effective communication strategies help ensure that LEP individuals receive timely information, in languages other than English, that helps them understand how the program operates and how to access services and retain eligibility.
In contrast, communication barriers can preclude LEP individuals from applying for or retaining eligibility in these programs or from receiving full benefits. Offices' lack of resources and knowledge, or those placing a low priority on providing language services can create barriers for LEP clients. Resource constraints may include a shortage of bilingual staff and trained professional interpreters and translators. The lack of knowledge in benefit offices about LEP populations is also significant. According to a New York City survey, benefits office workers did not offer language services to 87 percent of LEP clients. These clients reported being turned away from Medicaid offices; made to wait excessive amounts of time before being served; required to bring an "informal" interpreter or rely on a non-confidential interpreter; and required to make repeated visits before receiving benefits.
Summary of Findings
Through surveys and site visits, the National Health Law Program (NHeLP) assessed language service programs and activities under way in state and local agencies and benefits offices that help people apply for and retain eligibility for Medicaid, SCHIP, and other publicly funded health programs. Some states have implemented or are developing department-wide language service plans. In others, the language service plan or policy applies to a specific subset of the department, such as the Medicaid agency within the Department of Health. Administrative subdivisions, such as Los Angeles County, have in some instances developed their own language services plans. Converting these plans from paper to practice can be a major challenge for benefits offices.
This study identified a number of innovative and replicable activities:
The results here represent one step toward identifying and evaluating the various models of providing linguistic access and cultural competency in health care. The activities described in this report clearly demonstrate that one size does not fit all when it comes to providing language services. Rather, the nature, scope and delivery approach will vary from state to state, community to community, and from one local benefits office to another. However, by borrowing and adapting from the activities already under way, benefits offices can make great strides toward improving health care access. Benefits offices that are developing language services should follow this eight-step process:
Step 1—Designate responsibility.
Step 2—Conduct ongoing analysis of language needs.
Step 3—Identify and work with resources in the community.
Step 4—Determine what language services to provide.
Step 5—Determine response to LEP individuals.
Step 6—Train staff.
Step 7—Notify LEP clients of available language services.
Step 8—Update activities after periodic review.
While determining appropriate language services depends on individual circumstances, benefits offices have an array of options that can be tailored to the needs of their LEP clients and the office's setting, size, and location. Offices may hire bilingual staff and contract interpreters, use in-person or telephone interpreters, or partner with other agencies and offices to share resources and costs.