¿Habla Español Su Mercado de Seguros Médicos? (Does Your Marketplace Speak Spanish?)

Does your marketplace speak Spanish? What about Chinese, Korean, Arabic or Tagalog? Health insurance marketplaces will open their doors to the public on October 1, but will they speak the language of those who apply? Almost one in four prospective marketplace applicants speaks a language other than English at home. Across the U.S., nearly 1 in 10 of all individuals are limited English proficient (LEP) and will likely need assistance communicating and applying for health insurance. Marketplaces and state Medicaid and CHIP agencies will need to ensure that policies and processes are in place to enable LEP consumers to successfully enroll in, use, and retain coverage. Is your state agency stumped about how to develop and deliver effective and cost-efficient language services? These five steps to improving language accessibility can help your state, and are easier than learning a new language!
1.  Know the Language Access Requirements: The Affordable Care Act (ACA) and federal civil rights laws require marketplaces, Medicaid and CHIP agencies to provide language services for people with limited English proficiency (LEP). Section 1557 of the ACA prohibits discrimination by any entity that receives federal funds, is created under Title I of the ACA, or by any program or activity administered by the federal government. In the final marketplace regulations, HHS specified that marketplaces are prohibited from discriminating. Regulations describing consumer assistance tools and marketplace programs require accessibility for LEP consumers including oral interpreting, written translations and taglines indicating the availability of language services. Marketplace notices must also meet these accessibility requirements. CCIIO’s “Letter to Issuers” (chapter 6, section 6) describes the “meaningful access” required for LEP consumers (as well as consumers with disabilities) and outlines the same accessibility requirements. Further, the regulations governing both appeals and the Summary of Benefits and Coverage also require access for LEP consumers. Finally, recent Medicaid and CHIP regulations, as well as policyguidance, outline requirements and reimbursement for language services.

• What types of organizations must follow these requirements? State agencies that receive federal funds. Also health insurance marketplaces since they were created under Title I of the ACA and all of the entities that contract with them, including qualified health plans, navigators and assisters. Health care providers who participate in federally funded programs like Medicaid, CHIP and Medicare are also included.
• What type of discrimination is prohibited? Discrimination based on race, color, national origin, sex, gender identity, age, and disability. National origin discrimination includes discrimination based on the language an individual speaks so effective language services must be in place to assist LEP consumers.

2.  Conduct a Needs Assessment:  Determine the languages spoken and written in your state and communities so you understand the range of languages spoken and percentages of the state population affected. Two great resources are the U.S. Census’ “language mapper” to help identify language needs in your state and the Migration Policy Institute’s Language Portal, offering linguistic diversity data at the county and state level.
3.  Evaluate What Services to Offer and How:  A checklist from the National Health Law Program (NHeLP) and Families USA offers a basic overview of how to meet the needs of LEP consumers in marketplaces. In Providing Language Services in State and Local Health-Related Benefits Offices: Examples From the Field, NHeLP offers promising practices, case studies of how to effectively and cost-efficiently provide language services, and a step-by-step suggested plan to implement language services.
4.  Identify Resources Available to Provide Needed Services: NHeLP’s language servicesresource guide offers a language services locator and multilingual tools and resources. LEP Guidance and other materials from HHS’ Office for Civil Rights (OCR) also offer information on resources to effectively provide language services.
5.  Let Your State’s Voice Be Heard:  Not sure if the current guidance will meet your needs or have a specific issue federal agencies should know?  On July 30^th, OCR released a “Request for Information” (RFI) relating to Section 1557 nondiscrimination requirements. Focusing on language access, the RFI seeks information on access to health programs and activities for LEP individuals, including standards for translation and interpretation services, experiences of covered entities and individuals in the provision of language access services, and examples of effective services. Comments are due September 30, 2013, so there’s still time to communicate your state’s priorities in meeting the needs of vulnerable and underserved populations in your state.
Making sure health coverage programs are accessible to all applicants who walk through the door will take a concerted effort by states, but these simple steps can guide your way.  Before you know it, your state will be saying, “¡Bienvenidos a la cobertura médica!” (Welcome to medical coverage!)