+100 languages spoken in Pennsylvania Healthcare Interpreter Services (HIS) In the Pennsylvania Medicaid Program: A Policy Proposal Anne Marlay Masters of Public Health Capstone Project Jefferson College of Population Health Barriers uppercase in PA Medicaid Limited English proficient LEP Aim: Develop A Objectives Conduct State managed care organization (DOH) Interview State delete with (Washington, D.C.) Leave space in methods “Evaluate four domains in programs” Use bulletts Lower case after first letter Third column Results, Washington, Delete periods Uppercase state, lowercase a Uppercase state, lowercase in healthcare interpreter Uppercase state, lowercase healthcare interpreter BACKGROUND: Language Barriers within PA Medicaid METHODS DISCUSSION & LIMITATIONS +100 languages spoken in Pennsylvania Limited English proficient (LEP) Individuals 4% of total population 6.2% of Pennsylvania Medicaid population 11.3% of uninsured population Review 12 States and Washington DC programs and policies Review State Department of Health (DOH), Medicaid websites Review managed care organization (MCO) Medicaid contracts and handbooks Interview with State Medicaid administrators, stakeholders Review current PA HIS policies Review PA DOH website Review MCO Medicaid contract and provider/member handbooks Develop three policy proposals to improve PA Medicaid HIS policy Select most feasible, effective proposal as best option Evaluate programs in for domains Administrative cost or covered claim Reimbursement mechanisms Quality assurance components Capacity Managed care models are becoming main method of delivering Medicaid services and other benefits; State managed care contract can include requirements for HIS Washington State has most comprehensive HIS, including a State run interpreter training and certification program and over 13,500 certified interpreters Despite their decades long program, in 2011, Washington State Medicaid reported 90% of in-person Russian language HIS requests fulfilled, 62% of Cambodian HIS requests fulfilled, and only 28% of Nepali and Tigrinya HIS requests fulfilled Most States do not have publically available data on HIS usage and expenditures Lack of data on impact of varying HIS policies on LEP Medicaid enrollees health outcomes limits ability to select most effective policy Need for further research into HIS needs, usage, and impact on health outcomes Barriers to Comprehensive Healthcare Interpreter Services Inconsistent payment mechanisms for HIS Qualified HIS workforce shortage Lack of HIS training, knowledge for healthcare providers/staff Despite Federal & State laws, LEP healthcare consumers experience gaps in comprehensive HIS. PA Medicaid program does not reimburse healthcare providers directly for HIS. PA Medicaid Policy Proposal Improve PA Medicaid HIS Increase PMPM to pay for HIS Require Healthcare provider/staff training Create LEP Patient CHW navigator role Stakeholder task force Mandate MCO HIS request and usage reporting RESULTS: Review of 12 States and Washington D.C. Varying uses of language banks, State healthcare interpreter rosters, language vendors Majority of States claim HIS as an administrative cost Predominant reimbursement mechanism is reimbursement to healthcare providers after initially incurring cost; some states allow interpreters to claim reimbursement Only Washington State requires healthcare interpreter certification; predominant quality assurance mechanism are grievance policies Lack of HIS is associated with LEP individuals having: Decreases and delays in preventive care High rates of ED visits compared to English proficient individuals Increases in hospital readmissions Increases in resource utilization Adverse health outcomes PA Medicaid Policy Proposal Options Adopt fee for service claim for HIS – allow interpreters to bill Medicaid directly for services State contract with language vendor/s to provide HIS in all outpatient settings Expand Medicaid MCO HIS obligations; Build in reporting mechanisms; Develop community based organization partnerships CORE COMPETENCIES Analytic/Assessment Skills 1A1. Describes factors affecting the health of a community (e.g., equity, income, education, environment) 1A7. Identifies gaps in data 1B1. Describes factors affecting the health of a community Policy Development/Program Planning Skills 2A2. Contributes to development of program goals and objectives 2A7. Describes implications of policies, programs, and services 2B11. Evaluates programs, policies and services 2C11. Explains the importance of evaluations of policies, programs and services Capstone Objective and Aims Objective: Develop a policy proposal that will improve timeliness, consistency, and quality of Healthcare Interpreter Services within the Pennsylvania Medicaid system Aims: Conduct policy analysis of 12 states and Washington D.C. Medicaid programs that have established HIS reimbursement mechanisms for healthcare providers Conduct policy analysis of Pennsylvania Medicaid current HIS Develop 3 policy proposals to improve current PA HIS and select 1 proposal as most feasible and effective option PA Medicaid Policy Proposal Expand Medicaid MCO and subcontracted MCO obligations to meet HIS needs of LEP populations Key Components: Increase per member per month cost to cover HIS and other communication services Establish reporting mechanisms for LEP populations, requests for HIS, and fulfillment of HIS requests Create stakeholder task force to oversee development of HIS qualification standards, workforce recruiting plans, and healthcare personnel training initiatives Community health worker healthcare navigator ACKNOWLEDGMENTS Capstone Chair: Martha Romney, RN, MS, JD, MPH Capstone Preceptor: David Delgado, PhD, MPH Clerkship Preceptor: Gretchen Shanfeld, MPH