Language access policy: Laws, funding, and certification

A challenge in outreach and the provision of medical services to diverse populations, such as migrant and seasonal farm workers (MSFW), is the barrier of limited English proficiency (LEP). There is no shortage of evidence regarding how inadequate language services negatively impact the quality of healthcare. Migrant health centers and community clinics struggle with the cost of providing qualified interpreters and providing other vital healthcare services to LEP patients when these services are not reimbursable by public programs. 

In an effort to address the needs of California’s diverse populations, the Department of Health Care Services (DHCS) convened the Medi-Cal Language Access Taskforce in 2006 to explore a federally reimbursable system of language access services.  Currently, only twelve other states have programs to provide direct federal reimbursement.  This session will share lessons learned from the Taskforce (TF), a group of government, advocacy and provider organizations that collaborated to find an economical and effective model for language services delivery and reimbursement under Medi-Cal (California’s Medicaid program). 

Successes:

A key success for the TF was the composition of the group (providers, consumers, and government), as well as their ability to stay organized and cohesive over the approximately 18 month process.  Equally as important was the State’s shared commitment to reimbursement for language services.   

The result of the collaboration was a report with recommendations to DHCS in June 2008. Based on an analysis of California’s diverse provider and patient population as well as language access models in other states, the TF recommended that California provide language access services through the use of language brokers and a direct provider billing system.  Under the recommended hybrid model, health care providers could choose to either 1) utilize a language broker to arrange interpretation services for them, or 2) make their own arrangements for interpretation and bill the state for those services.

The recommendation was supported by the CPCA’s clinics and migrant health centers because it advanced the innovative approaches that were already in place for language services at clinics. 

Challenges: 

While collaboration is never easy, the TF was able to use consensus decision-making to formulate recommendations to the State.  The main challenges were, and continue to be, implementation. A significant challenge is the State’s $14.5 billion deficit, and a proposal to reduce the deficit by cutting the number of “optional services” under Medi-Cal (i.e. language services). Other challenges include a dearth of data on LEP populations making it difficult to ascertain costs, and the increased cost of providing services with increased use.  Also currently lacks an infrastructure or network to support the delivery service model.

Advice:

Taskforce members learned several important lessons that others interested in similar efforts may find valuable. One very important lesson learned was the usefulness of developing both short and long-term strategies.  Since policy change is a long process, short-term strategies that were more quickly attainable were helpful in keeping TF members energized and engaged. It is helpful to realize that some progress is better than no progress.