Helping Your State Tackle Language Barriers in the Health Insurance Marketplace

By Guest Blogger

This blog was written by Elaine Saly, Policy Analyst for Families USA.

A central piece of any successful health coverage outreach and enrollment effort is an understanding of the barriers that prevent uninsured consumers from applying for and enrolling in health coverage. Experience with Medicaid and the Children’s Health Insurance Program (CHIP) shows that one of the most significant barriers to getting, keeping, and using health coverage is a lack of access to information and assistance in appropriate languages. Research shows that adults and children with limited English proficiency are significantly more likely to be uninsured than those who speak and understand English fluently.

For the new health insurance marketplaces (or “exchanges”), this is an issue of particular importance. One-quarter of the people projected to enroll in coverage through the marketplaces speak a language other than English at home. In order to overcome these language barriers and secure equitable access to coverage for as many of the uninsured as possible, marketplaces must provide information and assistance in a manner that is culturally and linguistically appropriate for the population they serve. The Affordable Care Act and federal civil rights and nondiscrimination laws also require that marketplaces provide access for diverse populations. The new marketplaces should use model standards and best practices, such as those provided in the enhanced National Standards for Culturally and Linguistically Appropriate Services, which was recently released by the Department of Health and Human Services, to ensure they are adequately meeting these legal requirements.

Families USA worked with the National Health Law Program (NHeLP) to develop a checklist to help stakeholders work with the health insurance marketplace in their state to ensure that its outreach efforts and enrollment options meet the needs of consumers with limited proficiency in English.

Here are a few examples, taken from the Language Access Checklist For Marketplace Implementation, of what states can do to provide accessible information and assistance to consumers with a limited proficiency in English:

  • Translate online and paper versions of the application that consumers will use to apply for health coverage into the most common languages in the state.
  • Include taglines on the application, marketplace website, and consumer notices in at least 15 languages to inform consumers about how to get information or help in another language.
  • Select organizations that provide bicultural and bilingual assistance to limited English proficiency populations to serve as navigators, in-person assisters, and certified application counselors that will help people learn about and enroll in coverage.
  • Train call-center representatives and all entities certified by the marketplace to provide enrollment assistance on how to assess language needs, secure interpretation services, and work effectively with language interpreters.
  • Ensure all entities that provide enrollment assistance have access to translated materials and trained interpreters who can provide competent translation assistance.

After marketplaces open for enrollment this fall, it will be critical to collect data on consumers’ experiences using the marketplace and to continue identifying enrollment barriers for consumers. Ensuring that marketplaces are effectively serving consumers will be an ongoing effort. Identifying barriers like the lack of access to information and assistance in a culturally and linguistically appropriate manner will enable marketplaces to refine outreach and enrollment strategies and to successfully enroll as many uninsured consumers as possible in the new coverage options.


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