By Mara Youdelman, National Health Law Program
As immigrant communities expand across the United States, many healthcare providers and patients have encountered communication barriers making it difficult for patients to receive proper care. Yet proper communication is as important to healthcare as a stethoscope. You can’t listen to someone’s heart without a stethoscope. How can you listen to a patient without being able to effectively communicate?
Congress and the Administration recognized the need for improved language services and included a provision in CHIPRA (signed into law one year ago next week) to increase funding to help states address those needs. Last summer, the Centers for Medicaid and Medicare Services (CMS) issued new guidance to states to implement section 201(b) of CHIPRA.
The Guidance explains how states can use Medicaid and CHIP funds to pay for language services – including oral interpreting and written translations. The new CHPRA provision increased the federal share of payments for language services for states. As background, states have two primary Medicaid/CHIP funding streams – payments for administrative expenses (e.g the costs of administering the Medicaid/CHIP program) and payments for covered services (e.g. clinical services outlined in a state’s State Plan like physician visits and hospital expenses). A state can claim language services as either administrative expenses or covered services, regardless of whether the language services are provided in a benefit office or in conjunction with a clinical encounter. The only difference is that to receive reimbursement for language services as a covered service, the state must add language services to its State Plan.
The CHIPRA provision increased language services’ payments for children enrolled in Medicaid and all CHIP enrollees (including adults). A state now receives the higher of 75% or a state’s FMAP (federal Medical assistance percentage or the amount the federal government reimburses the state for Medicaid/CHIP expenses) plus 5%. For example, since Georgia’s CHIP FMAP is 75.73%, Georgia would receive 80.73% of its language services costs reimbursed (75.73% plus 5%). CHIPRA did not increase reimbursement for adults in Medicaid so a state would get reimbursed the regular administrative reimbursement rate of 50% if the state counts language services or the state’s FMAP if it adopts language services as part of its Medicaid/CHIP covered services in its state plan.
We are very excited about this provision because it offers additional funding to states and, hopefully, will incentivize more states to directly pay for language services. The requirement to provide language services is one that applies to both state Medicaid/CHIP agencies and Medicaid/CHIP providers. State agencies must provide language services in their own operations and offices but there is no requirement for the state to pay for the language services that Medicaid/CHIP providers must provide. Thus the increase in federal funding may help states decide to help providers by paying the costs of language services when provided in conjunction with Medicaid/CHIP covered services.
And there are additional financial reasons to help Medicaid/CHIP providers ensure effective communication with their patients. Last year the National Health Law Program released a report highlighting the high costs of language barriers in malpractice. The report documents that one malpractice insurance carrier paid out over $5 million in damages, settlements, legal fees in a 2 year period. Further, 32 of 35 cases had a failure to utilize competent interpreters. As a result, 2 children and 3 adults died and others suffered major harm including amputation and organ damage.
Paying for language services also would assist Medicaid/CHIP providers in ensuring the competency of the language services provided and effective communication. Too many healthcare providers rely on family members, friends and even young children to interpret because they cannot afford to pay for interpreters. Yet untrained interpreters are prone to omissions, additions, substitutions, volunteered opinions, and semantic errors that can result in serious distortions of the content of clinician and patient exchanges. States could choose to set competency requirements for healthcare interpreters as a condition of reimbursement. As a side note, I’ve been serving as Chair of the Certification Commission for Healthcare Interpreters, which has developed a national credentialing program for healthcare interpreters to ensure their competency.
Since CHIPRA’s enactment, Iowa is the only new state to begin paying for language services. The 12 other states that had been paying for language services prior to the CHIPRA provision certainly have benefited from the increased payments (these states are Hawaii, Iowa, Idaho, Kansas, Maine, Minnesota, Montana, New Hampshire, Utah, Vermont, Washington, Washington DC, and Wyoming). But more states should come on board to ensure effective communication between providers and patients so that Medicaid and CHIP enrollees have real access to the services provided by Medicaid and CHIP.