Providing Language Services in State and Local Health-Related Benefits Offices: Examples from the Field
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PROVIDING LANGUAGE SERVICES IN STATE AND LOCAL HEALTH-RELATED BENEFITS OFFICES: EXAMPLES FROM THE FIELD Mara Youdelman, Jane Perkins, Jamie D. Brooks, and Deborah Reid National Health Law Program January 2007 ABSTRACT: Changing demographics, along with federal and state policies, have increased the need for effective models of providing language services to people with limited English proficiency. Many benefits offices, which help people apply for Medicaid and other public programs, lack knowledge and resources, creating barriers to access and care. To assess this environment, the National Health Law Program visited benefits offices and conducted telephone interviews and surveys. Certain strategies emerged as promising practices, defined as creative, effective methods replicable by others. These include written language access plans; recruiting bilingual staff for dual roles (e.g., front desk and interpreter positions); interpreter competency testing; training for interpreter staff; telephone language lines; community resources such as universities, local advocates, legal aid organizations, and refugee resettlement organizations; and tapping into underused funding sources. The authors include an eight-step plan to help benefit offices develop a strategy to meet the needs of clients. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This report and other Commonwealth Fund publications are available on the Fund’s Web site at www.cmwf.org and the National Health Law Program’s Web site at www.healthlaw.org. To learn about new Fund publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 995. CONTENTS About the Authors..........................................................................................................iv Acknowledgments ...........................................................................................................v Executive Summary........................................................................................................vi Introduction ....................................................................................................................1 Promising Practices for Health-Related Benefits Offices...................................................3 Funding Opportunities .................................................................................................. 15 Conclusion .................................................................................................................... 16 Examples from the Field ................................................................................................ 17 Arizona—Department of Economic Security ........................................................... 17 California—Los Angeles County Department of Public Social Services .................... 20 Idaho—Department of Health and Welfare.............................................................. 24 Illinois—Department of Human Services ................................................................. 30 Kentucky—Cabinet for Health and Family Services, Department for Community-Based Services....................................................... 34 Nebraska—Health and Human Services System ....................................................... 39 North Carolina—Department of Health and Human Services .................................. 41 Washington, D.C.—Medical Assistance Administration............................................ 48 Washington—Department of Social and Health Services.......................................... 51 Notes............................................................................................................................. 63 Appendix A. Suggested Plan for Implementing Language Services ................................. 65 Appendix B. Sample Forms and Materials ...................................................................... 71 Appendix C. Methodology.......................................................................................... 161 LIST OF FIGURES AND TABLES Figure 1 Ability to Speak English by Non-English-Language Speakers...........................3 Figure 2 LEP by Language Spoken ................................................................................6 Table Summary of Surveyed Models for Providing Language Assistance Services in Benefits Offices ............................................................................ 58 iii ABOUT THE AUTHORS Mara Youdelman, J.D., L.L.M., has been a staff attorney in the National Health Law Program’s (NHeLP’s) Washington, D.C., office for more than five years. She works on issues such as language access, civil rights, Medicaid, and racial and ethnic disparities in health care. She received her J.D. from Boston University School of Law and her L.L.M. from Georgetown University Law Center. Jane Perkins, J.D., M.P.H., has been with NHeLP for two decades. Currently the organization’s legal director, she is a nationally recognized expert in Medicaid, language access, civil rights, and children’s health. She received her J.D. from the University of North Carolina at Chapel Hill School of Law and her M.P.H. from the University of California, Berkeley, School of Public Health. Jamie D. Brooks, J.D., is a staff attorney in the Chapel Hill office of NHeLP, specializing in reproductive justice, health as a human right, and litigation support. She received her J.D. from American University Washington College of Law in 2003. Deborah Reid, J.D., M.P.S., has been a staff attorney with NHeLP since 2005, and primarily works on issues involving Medicaid, women’s reproductive rights, racial and ethnic health disparities, language access, and health information technology. She received her M.P.S. in health services administration from The New School and a J.D. from Rutgers Law School–Newark. iv ACKNOWLEDGMENTS This report could not have been written without the generous assistance of The Commonwealth Fund. We specifically would like to thank Anne Beal for her assistance. In addition, our thanks are due to all the individuals who completed the survey. Special thanks also go out to the individuals and their staff members who provided in- depth information about the programs highlighted in this report. These individuals are: Lydia Glasson and Juanita F. Francis (Ariz.); Eileen Kelly (Calif.); Heidi Gordon (Idaho); Grace Hou and Greg Diephouse (Ill.); Cathy Cox (Ky.); Robert Contreras (Neb.); Terry Hodges, Carlotta Dixon, and Carolyn Sexton (N.C.); Maude Holt and Joseph LaFleur (Wash., D.C.); and Nora Guzman-Dyrseth, Ashley Mai, and Jason Reed (Wash.). Additional individuals and organizations assisted us in disseminating the surveys. We wish to thank the National Immigration Law Center; National Council of Interpretation in Health Care; National Council of State Legislatures; National Association of Counties; National Asian Pacific American Legal Consortium; National LEP Task Force; National Association of Counties; and the American Public Human Services Association. Finally, we would like to thank our interns who provided assistance in gathering and assembling information and conducting telephone surveys, Chandra Napora and Travis Robey. Editorial support was provided by Nanci Healy and Deborah Lorber. This report describes a variety of ongoing activities designed to improve language services in state and local health-related benefits offices. Inclusion in this report does not signify endorsement by NHeLP. NHeLP offers this information to help interested persons understand the variety and complexities of language services. v EXECUTIVE SUMMARY Background 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.