Christina -- your point is very well taken.

I am with the Texas Health Institute and with support from the Kellogg Foundation, The California Endowment, and Kaiser Permanente, we released a report in March 2013 investigating progress and actions that states are taking to meet the cultural and linguistic requirements outlined in the ACA for health plans and exchange outreach and communication (not exactly health literacy, but certainly closely related).

What you describe generally echoes what we found related to ensuring cultural and linguistic competence—it is not a priority, and even when it is funding, staffing, and resources in many cases are limited as is time and many states are drawing on their experience with Medicaid or contracting out. Nonetheless, our report does highlight state-based exchanges in seven states--California, Colorado, Connecticut, Maryland, New York, Oregon, and Washington—and identifies promising efforts to address culture and language in exchange planning and outreach. For each state, we attempt to describe existing and established promising initiatives in cultural/linguistic competence that could potentially inform outreach and education efforts for diverse communities through the exchange. For example, the exchange in Maryland plans to work with the Maryland Healthcare Commission to apply the Maryland Race, Ethnicity, Language, Interpreter Needs, and Cultural Competence (RELICC) assessment, and also plans to establish exchange-based standards for language, culturally-appropriate interpretation, translation, and communication, reading level, formats accessible to those with disabilities, and others. Maryland's exchange itself would be responsible for monitoring and evaluating performance based on these standards for outreach and navigator functions. (I would be interested in hearing from Maryland whether and how this has rolled out).

The report also includes in its recommendations the need to draw on existing standards—such as the National Standards on Culturally and Linguistically Appropriate Services (CLAS) issued by OMH—to integrate key principles, strategies, and actions into exchange outreach. As you know, standards 4-7 (of 14) addressing language access services are required for recipients of federal funds.

Of course, much more needs to be done, and we would be interested in connecting with you to learn of other standards or principles on health literacy that can or should be integrated into exchange outreach and education. We will continue to roll out related reports and resources, and would benefit from your feedback (as well as that from others) on recommended actions state exchanges should be taking to reach people with limited English proficiency, low health literacy, immigrants, and other diverse and vulnerable populations often left out of insurance. For more information on our work, please visit: http://www.texashealthinstitute.org/health-care-reform.html.

Thank you for your thoughtful post. Nadia

Hi Abby:
Great question! We have some materials posted on State Refor(u)m, and are gathering additional information to find out more about outreach efforts on exchanges and health reform in general. We’re also hoping other states can contribute their insight to this discussion, so stay tuned! Here are some links to helpful documents from states already on State Refor(u)m:

http://www.statereforum.org/node/2406#comment-8564
http://www.statereforum.org/node/2378#comment-8405

We have worked to modify our outreach efforts to underserved populations that have typically never been involved in health care policy discussions before.

We are working with DC Council member outreach offices as well as ANC Commissioners to push our message and solicitation for input through local newspapers, churches, and schools.

Attached is a sample flyer, brochure, and the modified presentation we are using for these events.

A toolkit published by the Blue Cross Blue Shield of Massachusetts entitled "Effective Education, Outreach and Enrollment Approaches for Populations Newly Eligible for Health Coverage" provides resources helpful to other states in engaging consumers.

The toolkit is one in a series of five toolkits publised by the BCBSMA Foundation wtih funding support from the Robert Wood Johnson Foundation and developed in collaboration with the Massachusetts Health Insurance Connector Authority and the Massachusetts Office of Medicaid.