Health Reform & Language Access

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Mara Youdelman's presentation at the 7th Annual NCIHC Membership Meeting in Seattle, 2013

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Health Reform & Language Access

  1. 1. Health Reform & Language Access Mara Youdelman Managing Attorney, DC office youdelman@healthlaw.org NCIHC AMM – June 7, 2013
  2. 2. National Health Law Program • NHeLP protects and advances the health rights of low income and underserved individuals • The oldest non-profit of its kind, NHeLP advocates, educates and litigates at the federal and state level • Our language access work spans over 2 decades and focuses on improving policies & funding for language access at the federal level
  3. 3. What is “health reform”? • “Affordable Care Act”, “ACA” or “Obamacare” – will provide health insurance to virtually everyone in U.S. through public or private insurance • October 1, 2013 is the start of the first “open enrollment” period to apply for insurance • January 1, 2014 is when coverage starts • Goal is to streamline applications and make healthcare more affordable
  4. 4. What is an Exchange or Marketplace? • Individuals who do not have insurance can go to an “exchange” or “marketplace” to buy insurance  If you have insurance through your employer, Medicaid/CHIP, Medicare, you don’t have to go to an Exchange  One stop shopping to apply & pick a plan • Help paying premiums and cost-sharing is available for individuals under 400% FPL
  5. 5. LEP Enrollees • 23% of expected Exchange applicants speak a language other than English at home • About 95% of uninsured LEP individuals are < 400% FPL and will be eligible for help paying for insurance • Exchanges must not discriminate against LEP individuals to comply with Title VI and ACA’s sec. 1557 • Exchanges also have to comply with relevant state laws
  6. 6. Nondiscrimination – ACA sec. 1557 • Extends federal civil rights laws prohibiting discrimination on basis of race, color, national origin, gender and disability to:  any health program or activity receiving Federal financial assistance – Exchanges, Medicaid/CHIP agencies, QHPs, navigators, etc.  any program or activity administered by a federal Executive agency – FFE, Medicare  any entity established under Title 1 of PPACA – Exchanges  based on statutes in existence, inc. Title VI, Title IX, 504 of Rehab Act • HHS OCR to issue regulations, likely this year
  7. 7. Data Collection – ACA sec. 4302 • Applies to health care/public health programs, activities, and surveys  Collect race, ethnicity, primary language, sex, disability status of all applicants, recipients or participants  Collect sufficient data for statistically reliable estimates for subgroups  Medicaid to use OMB standards for race & ethnicity  CHIP to collect language data of enrollees & parents/guardians  Medicare to collect data
  8. 8. The Opportunities • New legal requirements  Sec. 1557 & 4302  Specific ACA mentions of C&L • New systems being built • New requirements for health plan participation
  9. 9. The Problems – Thresholds • Adoption of 10% threshold for translation AND oral communication for:  Summary of Benefits & Coverage  Appeals Notices
  10. 10. The Problems – Thresholds • Recent federal regulations adopted 10% threshold for language services • A 10% threshold leaves out millions of LEP individuals! 10% 5% 500 # Counties 255 565 1,284 # States 23 37 50 states plus DC, PR
  11. 11. The Problems – Enrolling • Selection & training of “assisters” • Training for call centers • Health plan networks may not include sufficient bilingual/bicultural providers or provide language services to treat LEP patients
  12. 12. The Problems – The Application • Failure to collect language data from all applicants, only household contact • Failure to provide translated application into any language other than Spanish  CMS will develop a “tool” in 7 languages (Vietnamese, French Creole, Chinese, Korean, Arabic, Portuguese & Polish)  CMS will support creation of similar tools in 17 languages
  13. 13. Now is the Time! • Right now, decisions are being made at federal and state level to implement health reform & language services • If we do not act quickly, it will be too late because adding/changing systems later costs $ • If your state has a state-based Exchange, get involved – send in your comments, talk at public meetings, organize others to provide input • If your state will use the “FFE”, get involved with federal policymaking
  14. 14. Resources • Language Access Checklist for Marketplace Implementation • Translation Glossaries: The Need for Standardization of ACA-related Terms • Short Paper 6: The ACA and Application of § 1557 and Title VI of the Civil Rights Act of 1964 to the Health Insurance Exchanges • Short Paper 5: The ACA and Language Access
  15. 15. THANK YOU! Washington DC Office Los Angeles Office North Carolina Office 1444 I Street NW, Suite 1105 Washington, DC 20005 ph: (202) 289-7661 fx: (202) 289-7724 nhelpdc@healthlaw.org 3701 Wilshire Blvd, Suite #750 Los Angeles, CA 90010 ph: (310) 204-6010 fx: (213) 368-0774 nhelp@healthlaw.org 101 East Weaver Street, Suite G-7 Carrboro, NC 27510 ph: (919) 968-6308 fx: (919) 968-8855 nhelpnc@healthlaw.org www.healthlaw.org

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