1. +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.)
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“Evaluate four domains in programs”
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Third column
Results, Washington,
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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