Health Equity
A strategic plan to advance health equity that addresses these specific, common areas of significant disparities can help states ensure that their strategies will reach the populations necessary to achieve population health goals.
*Milestone details:
*Full name: Develop or evaluate an existing strategic plan for advancing health equity to ensure it encompasses health disparities by race, culture and ethnicity, levels of education and income, and geographic area.
*Relevance to the ACA:
The ACA provides many resources to states with an interest in strategic planning for health equity, although this is not required by the law. A strategic plan empowers states to evaluate the impact of current state programs and policies, demonstrate areas of continued need, and take advantage of the health equity resources provided by the ACA. Some provisions that can advance health equity include:
§1311, §1513, §2001 – Provide access to health insurance for vulnerable communities.
§4001, §4002, §4201– Fund public health initiatives that address social determinants of health and other prevention strategies.
§4302 – Requires federally-funded health care and public health programs to follow new standards for collecting data on race, ethnicity, sex, primary language, and disability status.
§5301, §5309, §5313, §5402 – Increase diversity and cultural competence among health care providers.
less
comment, ask a question or post a document
Login or Register to participate in this discussion or post a document
Washington
Sponsored by the National Council on Interpreting in Health Care ( NCIHC)
http://www.ncihc.org/
WEBINAR: Opportunity and Challenge: Language Access for the Health Benefits Marketplace
Will health care reform increase access to care for consumers with limited English proficiency?
Date: Wednesday, March 20, 2013
Time: 11:00 AM -12:30 PM CDT
The promise of the Affordable Care Act (ACA) is coming ever closer to reality, as the Health Benefits Marketplaces (HBM) will open for business in October of this year, to enroll consumers in the new public and private insurance plans that start in January 2014. For many people , this will be the first time that they will be able to obtain health insurance for themselves and their families. Nationwide, about 1 in 4, or 23%, of consumers who will be eligible for the news plans have limited English proficiency (LEP).
Register here: https://www1.gotomeeting.com/register/886713400
What is not yet certain is how their language needs will be met as they seek to inform themselves about options, go through the enrollment process, and start using insurance and healthcare services. The ACA itself contains Non-Discrimination mandates, and Title VI of the Civil Rights Act also governs the HBMs as recipients of federal funds; plus there are state laws and rules that apply as well, in specific locales. Making meaningful language access services a part of HBM operations and services is a complex process, as we will learn from advocates from around the country . This webinar will offer an overview of the ACA , the HBMs, the legal and policy framework for quality language services for LEP consumers, plus the critical importance of advocacy for ensuring equal access. Participants will learn what's going on nationally, and at the state level, with a focus on understanding the issues, strategies for addressing systemic barriers , and recommendations of helpful resources for policy education. Advocates from California,New York, and Washington will share first-hand accounts about their experiences-- both past and still in progress--working to overcome the challenges to achieve maximum public benefit from this new opportunity.
The panelists are:
Mara Youdelman- National Health Law Program,Washington,DC
Nisha Agarwal, Center for New Democracy, New York
Doreena Wong, Asian and Pacific Islander American Legal Center,California
Gillian Dutton, Seattle University School of Law, Washington State
Joana Ramos, Washington State Coalition for Language Access
Panel Organizer: Wilma Alvarado-Little, NCIHC Board Member and Chair of the Policy and Research Committee
Facilitator: Ann Bagchi, Vice-Chair, NCIHC Policy and Research Committee
Washington
At the Dec. 19 meeting of the Health Benefits Exchange Board, Exchange CEO Richard Onizuka announced that a new staff position has been created for a "Translation and Printing Program Specialist", and recruitment is now underway. See link for the job description .
Washington
Here is the brief: Language Access in Washington Under the Patient Protection & Affordable Care Act"
Washington
On Dec. 10, the Washington State Coalition for Language Access and Northwest Health Law Advocates released a brief entitled "Language Access in Washington Under the Patient Protection & Affordable Care Act," which is also available on the WASCLA website at www.wascla.org. The guide describes the language access considerations and concerns as the ACA is implemented in Washington State, and makes recommendations for including meaningful language access services an integral part of Washington's Health Benefits Exchange. Advocates have been working on this issue for many months, and the document is a result of this effort. The report is currently being studied by the Policy Committee of the the Exchange Board, which makes recommendations to the Board .
Among recent concerns about the WA Exchange are it's current lack of a general Language Access Plan; plans for the consumer website to be available only in English and Spanish and without multilingual taglines; and limiting of telephonic interpretation services to be offered by the Exchange call center just to WA's 8 threshold languages.
The report contains discussion of population needs and analysis of language access requirements for Exchange operations and services, and much more.
Joana Ramos
email: jdramos@wascla.org
Member, Board of Directors
Chair, Healthcare Committee
Washington State Coalition for Language Access
www.wascla.org
Florida
Interested to learn if all QHP's also have to comply with the Language Access, or 508 Rule. Secondary question would be, if we do and English is not the primary language with all related documents sent to the subscriber need to be stored in both English and the Primary language of the Subscriber? Thank you in advance for your feedback
Washington
Yes, there are language access requirements for QHPs. You can read more in the brief from WA State that I am posting today on this site.
I don't know the answer to your question on document storage ,and suggest you request technical assistance on that topic.
Washington
I'd like to hear from everyone about what's going on in your states towards ensuring high-quality language access services into all aspects of planning Exchange implementation and operations.
Thank you.
Joana Ramos
Washington
California
Hi Joana – In California we have been taking a multi-pronged approach to this issue with some success but we still have a ways to go!
When California established its Exchange through state legislation, we required the Exchange to provide translations in prevalent languages and interpretation in any language as required by Federal Law - so this became the basis for our work below.
When our state Exchange considered applying for its first Level I grant, we successfully advocated for the Exchange to seek funding for a staff person to coordinate cultural and linguistic access to the Exchange. We are following up with the Exchange now to find out what their plans are for this position.
We also reviewed with a dozen other advocates the Exchange’s Request for Proposal (RFP) and accompanying Business Systems Requirements for IT vendors interested in bidding on a contract to build the IT system for the Exchange. As part of that review, we confirmed that California’s Exchange web portal will be available in English and Spanish. We also advocated successfully for the Exchange’s IT system (called CalHEERs) to generate notices in the 13 Medi-Cal Managed Care threshold languages in California as well as to provide links to phone, online chat, or Interactive Voice Response (IVR) assistance on their website in those languages. We are working with the Exchange now to better understand the process they will use to ensure that translations of the web portal, notices, links to phone, online chat or IVR are high-quality and culturally and linguistically appropriate. Like other efforts, this will require an ongoing stakeholder process with Exchange IT staff over the next year as they build and test the system internally and with consumer stakeholder groups.
Besides implementation and operations, other areas we have focused on include: 1) Marketing and outreach (e.g. ensuring sufficient resources for focus groups and partnerships with community based organizations to market and outreach to communities in Spanish and other prevalent languages in California.) 2) Navigator program (e.g. ensuring the Exchange contracts with Navigators who are able to reach hard-to-reach populations, including Limited-English Proficient in California).
Hope this helps! If you have any questions about any of the above, please do not hesitate to call or email me at the California Pan-Ethnic Health Network.
Best,
Cary Sanders
California
Texas
Hi Joana,
We (at the Texas Health Institute) currently have support from Kaiser Permanente, W.K. Kellogg Foundation and The California Endowment to monitor and assess the implementation progress of over 60 provisions addressing language access, cultural competence and other diversity/equity objectives. Among these are requirements for the exchanges.
As you well know, the reality is that many states have only just started the planning process. And with the recent extension of the deadline to establish exchanges, many are still far behind. Several states, however, are making progress to address cultural/linguistic appropriateness in exchange planning and operations. Though we do not yet have a lot of details as you are probably searching for, we have learned some interesting things--echoing in many cases what Cary Sanders of CPEHN points out.
States that are most ahead on language and cultural issues in the exchanges, like California, Maryland, and your own state of Washington, have passed legislation addressing equity and have active advocacy groups and influential people who can keep these issues in the forefront of planning, as several people we have spoken with said that addressing these issues needs to be a core part of the mission and integrated into all aspects exchange planning, and not be an afterthought. A lot of states seem to understandably be looking at existing language programs they have such as for Medicaid and seeing how they can adapt that model to meet the requirements of the exchanges. Also, many health plans and hospitals have established translation and interpretation programs for their patients that can serve as models for state exchanges.
Following are a few links to information on states and language access you and others may find helpful:
• Again, as Cary mentions, California is probably the most ahead of the curve since they have required language services in all health plans for a number of years now after the passage of SB 853—here is a report describing its key provisions on language: http://www.statereforum.org/discussions/cultural-competency (see pp. 7-8). California plans to make outreach documents available in the state’s 13 Medicaid threshold languages (more than the 5 required by the ACA) and plans to share resources and experience in this with other states: see p. 13 (16 of PDF) at http://www.healthexchange.ca.gov/StakeHolders/Documents/CHBE,DHCS,MRMIB_....
• A recent presentation in Maryland shows what they plan to do (slide 15) and issues/questions remaining around language access: http://dhmh.maryland.gov/exchange/pdf/Navigator%20Presentation_Manatt_9%....
• Here is info on New York’s new free language access rule for all state agencies: http://www.governor.ny.gov/press/10102012FREELANGUAGE%20ACCESS.
• Page 5 of this report from Community Catalyst has recommendations for state exchanges regarding language access: http://www.communitycatalyst.org/doc_store/publications/Health_Equity_th....
• As you may know, the National Health Law Program has also done a lot of work on language access in health care: http://www.healthlaw.org/index.php?option=com_content&view=article&id=23...
We hope this helps and hope that other state-level exchange people will chime in here with more details, successes, and challenges of what they are working on in this area. We, too, hope to have further updates and details in the coming months as we work to coalesce this information and put out an initial draft of our report, highlighting state-level progress, practices and lessons. The report is expected out in March 2013, coinciding with the National Conference on Quality Healthcare for Culturally Diverse Populations in Oakland, California.
Washington
Hi Cary and Nadia,
Thanks for your thoughtful and detailed replies. The reason I asked the question beyond the obvious is to get ideas for strategies to address the serious challenges we seem to be facing here in WA on implementing language access services into our Exchange. You are correct that we have a good deal of expertise in language access services in our state, which makes the current situation even more concerning.
First, a brief intro. I am a founding member and current Board member & Chair of the Healthcare Committee of the Washington State Coalition for Language Access ( WASCLA), to which I bring my background as an independent health policy consultant and a professional medical interpreter holding state & national CCHI credentials. WASCLA does a lot of training on the legal & policy framework for language access services, and offers implementation support through collaborative efforts statewide.
For the Health Benefits Exchange, now under the moniker of Washington HealthPlanFinder We have similar advocacy efforts underway here, as you note, and I serve as WASCLA's representative to the Healthy Washington Coalition. Through HWC, I participate with folks from other allied organizations in several subgroups tasked with monitoring and advising on equity issues for various aspects of our Exchange in development, including review of forms, notices, website; plans for Navigator & Consumer Assistance functions, the call center, and of course the communications access pieces for all operations. I also a member of the Consumer Workgroup to the Exchange, under the auspices of WA's Health Care Authority.
So far, despite the best efforts ( educational & requests for info) by many of us , and our successful mobilization to respond on incredibly short notice to official requests for comments( such as for notices & forms) we have still have no information on specific language access topics relative to the Exchange. To give a few examples, we do not know, what the translation plan is for the forms and notices. I have recruited additional qualified volunteers to review language-specific translations like we do for the English documents , but so far nothing has come our way. To date, WA does not have a Language Access Plan for the Exchange. Most recently, we have learned that, for reasons unknown, the current plan is for the inaugural WA HealthPlanfinder website to be available only in English and Spanish, and not to include even taglines in our 7 other threshold languages, for which WA certifies medical & social services interpreters. About 50% of our LEP population speaks Spanish, and the most-spoken other languages now actually number 10-15. While our state profile is different than that of CA or TX, per Census 2010, our population with LEP now numbers 512K, or 8 % of state population, 4% are deaf/HoH and 2% blind or visually impaired.
Naturally our advocacy work continues on all of these matters. I have provided extensive info on demographics of language needs in WA, for populations with LEP in spoken/written languages, and on the basis of disabilities ,cognitive needs, and literacy and health literacy . While overall there have been positive responses to our collective feedback on a number of topics, such as the need for application of the required Plain Talk principles to written communications, responses on any language services aspects have been largely absent.
We have also had some general challenges in getting submissions of written testimony into the record & sent to the Exchange Board members. We are suggesting now that all written comments be posted on the website.
That is a great idea about a designated staff person to coordinate cultural /linguistic access to Exchange services,; we might think about how that might still be possible here.
WASCLA has its own resource challenges , which is why we work closely with advocacy partners through the HWC. We rely on allies locally like the Northwest Justice Project, Northwest Health Law Advocates ( NoHLA), the Children's Alliance, and nationally like NHeLP and the National Council on Interpreting in Health Care, just to name a few.
So that's why I am very interested to learn what is going on in other states around ensuring full, high-quality language access services ( not just the words "linguistically competent" as bi-/multilingual fluency does not equate with competence to transmit messages accurately, another of our education endeavors) be an integral part of our Exchanges,and to network with all of you. Look for more info on the topic from WA coming soon. And feel free to contact me directly to disucss further.
Joana Ramos
Chair, Healthcare Committee
Washington State Coalition for Language Access ( WASCLA)
http://www.wascla.org/
wascla.lep@gmail.com
Texas
With support from the Joint Center for Political and Economic Studies, the Texas Health Institute released a report in Summer 2010 describing specific opportunities embedded within the ACA for advancing health equity for racially and ethnically diverse communities. Over three dozen health equity, diversity, language and cultural competence specific provisions are highlighted from ACA. The Texas Health Institute continues to drill further into these provisions to track implementation status and progress.
Virginia
The Synthesis Project, an initiative of the Robert Wood Johnson Foundation, conducted a synthesis of the literature on racial and ethnic disparities. Jose Escarce was the author. The research synthesis and companion policy brief have been uploaded.
District of Columbia
The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. State alignment with these strategies will build foster greater synergy to promote health equity.
District of Columbia
Hi Susan! Michigan Health Promotion for People with Disabilities Initiative is a statewide partnership committed to reducing the health disparities between people with disabilities and people without disabilities through member collaboration, expertise, and leveraged resources. Several years ago they published an innovative strategic plan to address disability disparities. Is anyone familiar with more recent examples of state plans re: disability disparities?
New York
I see that Maryland has a plan for addressing racial/ethnic disparities. Promoting health equity must also address disparities based on disabilities. Is there a State that has addressed this population in the formulation of its plan?
District of Columbia
This report contains recommendations based on the implementation planning and of the Coordinating Council and its six workgroups, as well as input from the public.
Access the report here: http://www.statereforum.org/sites/default/files/md_final_report.pdf