NCSL: LegisBrief: Language Services Under SCHIP

NCSL LegisBrief

Briefing Papers On the Important Issues of the Day

Language Services Under SCHIP

By Gabriela Alcalde and Ann Morse

Nov./Dec. 2000
Volume 8, Number 46

The State Children's Health Insurance Program (SCHIP) represents a promising tool for insuring children whose families have incomes too high for Medicaid but too low to afford private coverage. Children in immigrant families are at particularly high risk of being uninsured and of not receiving needed medical care. In the United States, one in five children lives in an immigrant family or is an immigrant. The majority of these children-about 75 percent-are U.S. citizens and therefore eligible for public programs such as SCHIP.

Barriers to Enrolling in SCHIP. Children of immigrants face a number of barriers to enrolling in SCHIP and receiving appropriate care: complex eligibility categories for immigrants, fear of adverse decisions by the Immigration and Naturalization Service, access to care issues, lack of knowledge, and language barriers. Of these, language is the most pervasive and can exacerbate every other obstacle encountered. Approximately 14 percent of the U.S. population speak a language other than English at home. People with limited English proficiency face problems at every level of the health care system-in knowledge and understanding the system, in the enrollment and administrative process, and at the clinical and service level. Language barriers can result in the denial of needed medical care, in delays in receiving medical care and, at times, inadequate care due to imprecise or incomplete information.

State Actions

Because all U.S. citizens, as well as certain groups of legal immigrants, are eligible for SCHIP, regardless of the immigration status of other family members, and because of the high uninsurance rate of children in immigrant families, states are exploring ways to remedy this problem. They are responding by developing outreach and enrollment programs that are linguistically and culturally appropriate and are making the health care system easier to navigate for those who speak very little English.

All entities that receive HHS funds-including state agencies, managed care plans and hospitals- must take adequate steps to ensure that individuals receive the language assistance necessary to afford them "meaningful" access to services, free of charge. The guidance suggests assessment of language needs of the population to be served; training of staff; monitoring; provision of trained interpreters; translation of written materials; and notifying people regarding their right to language assistance and the availability of such assistance free of charge.

NCSL conducted an informal survey in late 1999 and early 2000 of the 13 states with the highest percentage of immigrants to gauge the range of language services provided under SCHIP. States included were: Arizona, California, Florida, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, Pennsylvania, Texas, Virginia and Washington.

All of the states surveyed except Virginia provided interpreter services. These services ranged from the use of the AT&T language hotline-which provides up to 140 languages-to community-based organizations, bilingual staff, and friends and relatives.

Multilingual Workers. The availability of multilingual eligibility workers was equally diverse. Seven states had multilingual workers or interpreters available during nontraditional hours (evenings and weekends). In New York, an initiative called "facilitated enrollment" is planned. Under it, eligibility and enrollment workers will be in communities to help families apply for the programs their children may be eligible for. Workers will be available during nontraditional hours and will have appropriate linguistic and cultural skills.

Languages Available. States choose the languages to be served based on census reports, application experiences and specific studies. California offers services in what are called the 10 threshold languages (Spanish, Vietnamese, Cambodian, Laotian, Hmong, Armenian, Cantonese, Korean, Russian and Farsi). In Arizona, health plans are required to provide information in a specific language if at least 5 percent or 200 of their members speak that language. Community organizations in Texas that serve refugees and immigrants provide services in their native languages. States that depend on the AT&T language service note that the 140 languages it provides far exceeds their needs.

Most states surveyed printed their SCHIP applications in English and Spanish. Virginia provides an application in English only; California's application is in all 10 threshold languages; Florida in English, Creole and Spanish; and Michigan in Arabic, English and Spanish. Some states with applications only in English and Spanish do print outreach materials and brochures in additional languages. Some states have placed ads in other languages in mainstream media channels, whereas a few states actually use ethnic newspapers, newsletters and radio stations to reach these communities.

Massachusetts provides minigrants and monthly meetings to the 58 community organizations currently participating in SCHIP outreach activities. New York and Texas also provide grants or state funding for outreach. New Jersey, California, Michigan and Illinois provide a $25 to $50 fee for each completed and approved application the community organization submits. Most states provide technical support assistance or periodic meetings with these community organizations, which range from health centers, to faith-based centers, churches or organizations, to public schools, child care agencies, health departments and others. Seven of the states surveyed had conducted or were planning to conduct some level of cultural sensitivity training for state agency employees and managed care providers.

Selected References

Morse, Ann. SCHIP and Access for Children in Immigrant Families. Washington, D.C.: National Conference of State Legislatures, January 2000.

Title VI of the Civil Rights Act of 1964; Policy Guidance on the Prohibition Against National Origin Discrimination as it Affects Persons With Limited English Proficiency, Washington, D.C.: U.S. Department of Health and Human Services, Office of Civil Rights, Aug. 30, 2000. http://www.hhs.gov/ocr/lep/

Contact for More Information

Ann Morse
NCSL-Washington, D.C.
(202) 624-8697

Health and Human Services Office of Civil Rights
(202) 619-0403
http://www.hhs.gov/progorg/ocr/regmail.html#regoff