Including Language Access into Medicaid ACO Design

Abstract

Quality health care relies upon communication in a patient's preferred language. Language access in health care occurs when individuals are: (1) Welcomed by providers regardless of language ability; and (2) Offered quality language services as part of their care. Federal law generally requires access to health care and quality language services for deaf and Limited English Proficient (LEP) patients in health care settings, but these patients still find it hard to access health care and quality language services.Meanwhile, several states are implementing Medicaid Accountable Care Organization (ACO) initiatives to reduce health care costs and improve health care quality. Alternative payment methods used in these initiatives can give Accountable Care Organizations more flexibility to design linguistically accessible care, but they can also put ACOs at increased financial risk for the cost of care. If these new payment methods do not account for differences in patient language needs, ACO initiatives could have the unintended consequence of rewarding ACOs who do not reach out to deaf and LEP communities or offer quality language services.We reviewed public documents related to Medicaid ACO initiatives in six states. Some of these documents address language access. More could be done, however, to pay for language access efforts. This article describes Medicaid ACO initiatives and explores how different payment tools could be leveraged to reward ACOs for increased access to care and quality language services. We find that a combination of payment tools might be helpful to encourage both access and quality.

Medicaid Expansions and Access to Substance Abuse Treatment Services Among Limited English Proficiency Populations

“…16 Although the Center for Medicare and Medicaid Services provides higher reimbursement rates for the utilization of the services in expansion states, only 15 states currently offer reimbursement to Medicaid patients since there is no obligation to match the costs by states. 17,18 Increased coverage of behavioral health services is another pronounced benefit of the ACA. Through the extension of the Mental Health Parity and Addiction Equity Act of 2008, over 27 million previously uninsured people have gained access to mental health and substance abuse treatment (SAT) services.…”

“…It is also possible that the physicians’ misperception stemmed from challenges of obtaining reimbursement due to the absence of the policy mandating the reimbursement for language services 16 . Although the Center for Medicare and Medicaid Services provides higher reimbursement rates for the utilization of the services in expansion states, only 15 states currently offer reimbursement to Medicaid patients since there is no obligation to match the costs by states 17,18 …”

Commentary on Patient-Provider Communication Quality, 2002–2016

“…Culturally and linguistically appropriate services are vital to improving the quality of health services provided to all individuals, specifically those who have limited English proficiency (LEP). Quality health care and patient outcomes rely upon being able to communicate with providers, especially in a patient’s preferred language 4. This requires having access to health care and quality languages services for patients with LEP in the health care setting as directed in Title VI of the Civil Rights Act of 1964 5.…”

“…Quality health care and patient outcomes rely upon being able to communicate with providers, especially in a patient's preferred language. 4 This requires having access to health care and quality languages services for patients with LEP in the health care setting as directed in Title VI of the Civil Rights Act of 1964. 5 Yet, studies consistently show that Asian Americans continuously report worse health care experiences than any other racial and ethnic groups in the United States.…”

Medicaid Patients’ Use of Dental Benefits

“…The majority of these immigrants come from non-English Roshdy, 10 speaking countries and can be referred to as Limited English Proficiency (LEP) individuals. In fact, LEP makes up 9% of the US population and 12% of Medicaid enrollees (Gershon et al, 2016;Gonzalez, 2014).…”