speaking the language of care: language access and the affordable care act
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Speaking the Language of Care: Language Access and the Affordable Care Act. Cary Sanders, MPP January 24, 2014. CPEHN: Together We’re Stronger. Eliminating Health Disparities. Coverage does not always equal access. Timely Access. Affordability. Network Adequacy. Cultural & Linguistic - PowerPoint PPT PresentationTRANSCRIPT
Speaking the Language of Care: Language Access and the Affordable
Care Act
Cary Sanders, MPPJanuary 24, 2014
CPEHN: Together We’re Stronger
Eliminating Health Disparities
Coverage does not always equal access
Network Adequacy
GeographicAccess
Cultural &Linguistic
Access
Timely Access
Affordability
Foundations for Language Access
Federal – Title VI, Civil Rights Act 1964– Executive Order 13166 and LEP Guidances– Office of Minority Health Cultural and Linguistic Appropriate
Services (CLAS) Standards
California– State Title VI Look-Alike (Government Code 11135-11139.8)– Dymally-Alatorre Act– Medi-Cal Managed Care Contract Provisions and Policy
Letters– Department of Managed Health Care SB 853 (Escutia)– Kopp Act
1
Title VI, Civil Rights Act of 1964
Applies to all entities that receive federal funding
Prohibits discrimination on the basis of race, color, or national origin (“national origin” includes Limited English Proficient persons)
www.lep.gov
2
State Title VI Look-Alike
California has a state law that “looks like” Title VI. It is similar to Title VI but is broader, in that:
Individuals have the right to sue, in discrimination cases based on race, national origin, ethnic group identification or color.
Unlike in Title VI, individuals may sue in “disparate impact” cases. This means that even when an agency didn’t mean to hurt a group of people, it did so in its normal practices. In this case, an individual may sue that agency.
Applies to “any program or activity that is conducted, operated or administered by the state or any state agency directly or receives any financial assistance from the state”
3
Medi-Cal Expansion
Of the 1.42 million adults newly eligible for Medi-Cal, 67% (950,000) will be people of color
Latino: 48%
White: 33%
African American: 8%
A&PI: 7%Other & Multiple
Race: 4%
CPEHN, Medi-Cal Expansion: What’s at Stake for Communities of Color, 2013
Medi-Cal Expansion
Of the 1.42 million adults newly eligible for Medi-Cal, 35% (500,000) will speak English less than very well
Spanish Cantonese Vietnamese Korean Tagalog
389,100 34,900 25,200 14,700 10,100
CHIS 2009 and CalSIM 1.8
Medi-Cal Managed Care
Applies to Medi-Cal managed care health plans
Requirements– Provide 24 hour free interpretation at all points of
service – Translate key materials in threshold languages– Assess linguistic capabilities of interpreters and
bilingual provider– Maintain Community Advisory Committee– Conduct group Needs Assessment
5
Medi-Cal Managed Care (continued)
Written translations– Threshold: 3,000 in service area, 1,000 per ZIP code, or 1,500
per two contiguous ZIP codes– List of informing materials– Timeline– Recommended process for quality assurance
Oral interpretation– Comply with Title VI, plans must ensure access to interpreters
for all LEP members– No unreasonable delays– Cannot require or suggest that member provide interpreter– Services at no cost to member
6
Covered California
Of the 2.7 million eligible for tax credits, 66% (~1.8 million) will be people of color
NA/AN & Multiple Race:
2%A&PI: 14%
African American: 4%
Latino: 47%
White: 32%
CPEHN, Achieving Equity by Building a Bridge from Eligible to Enrolled, 2013
Covered California
Of the 2.7 million eligible for tax credits, 40% (~1.09 million) will speak English less than very well
Spanish Mandarin Cantonese Vietnamese Tagalog Korean
721,200 66,600 61,600 50,000 27,600 18,700
CHIS 2009 and CalSIM 1.8
SB 853
Applies to all health plans and insurers
Requirements– Collect race, ethnicity, and language data– Provide access to interpreter at all points of contact– Translate vital documents
Monitored by the Department of Managed Health Care and the California Department of Insurance
7
SB 853 (continued)
Written translations– Thresholds
>1,000,000 members top two languages and at 0.75 percent or 15,000
>300,000 members top languages and at 1 percent or 6,000
<300,000 members 5 percent or 3,000
– Provides examples of vital documents and exempts member specific materials
Oral interpretation– No cost to member– Outlines interpreter proficiency qualifications 8
Covered CaliforniaLanguage Access Services
Translate materials into 13 Medi-Cal managed care threshold languages
CalHEERS available in Spanish Oral interpretation in all languages
Intent to hire bilingual customer service representatives for 13 Medi-Cal managed care threshold languages
Dedicated 800 numbers in each language
Cultural Competency/Cultural Humility
Genuine sensitivity and respect regardless of ethnicity, race, language, culture or national origin
Applying understanding of patient’s background, cultural values, and beliefs in health context
– Example: The Spirit Catches You and You Fall Down
Next Steps: Measuring Quality Care
Require Medicaid health plans/QHPs to collect and analyze quality data by race, ethnicity and primary language
– Exchanges
Federal Guidelines
– Adoption of CAHPS Cultural Competency Measure Set
Use of translated CAHPS should be required
Clinical measures disaggregated by race, ethnicity and primary language
Oversampling in smaller ethnic populations
State Requirements (e.g. Evalue8 Module 1.7)
– Medicaid
Require collection and analysis of EQRO data by race, ethnicity and primary language
Next Steps: Measuring Quality Care
Make quality information more accessible/transparent for consumers
– Post quality measures on Medicaid/Exchange website by race, ethnicity and primary language
– Provide Provider Directories that sort by:– Doctor and/or Essential Community Provider
– Languages spoken
– Geographic region
Next Steps: Invest in OERU
Invest sufficient resources in Outreach, Enrollment, Retention and Utilization (OERU)– In-Person Assisters/Navigators extremely
important for LEP, immigrants and other vulnerable populations!
– Retention and Utilization often neglected “I worry that people won’t be able to figure out where to
go to see a doctor once they get their insurance card.” – Denise Lamb, Black Women for Wellness