The Importance of Health Care Access Among Hispanic Older Adults

December 13, 2012

Statement for Capitol Hill Briefing

“The Importance of Health Care Access Among Hispanic Older Adults”

Fay Gordon, Staff Attorney

Hello, thank you for inviting the National Senior Citizens Law Center to participate in this timely and important briefing.  NSCLC is a non-for-profit organization whose principal mission is to protect the rights of low-income older adults.  For years, we’ve worked with national and state advocates, some groups are in this room, on administrative advocacy to ensure that Medicare, Medicaid and private plans provide limited English proficient (LEP) older adults with equal access to health care services.  There is room for improvement to reduce health disparities by breaking down language barriers, but we are encouraged by the enhanced attention CMS has granted to the issues of language access in recent years.  I would like to briefly discuss the need for continued language access advocacy, and share some insight on advocacy efforts to improve access to Medicare for LEP seniors.

A language barrier in Medicare, particularly in the Part D program, is a real and important problem for an LEP senior.  As we know, if individuals do not receive health information in a language they understand, their medication management, access to preventive care, outcomes in an emergency room, and more may be in jeopardy.  Last month,[1] RAND released a study on disparities in Part D experiences.  They found that culture, language, and health literacy continue to be a barrier in navigating the Medicare Part D program.  Spanish-preferring older adults and Asian Pacific Islander older adults face the greatest disparity.  The study also pointed out that Spanish speaking older adults are more likely to be concentrated in poor performing managed care plans than which non-Hispanic white patients.

Current demographic trends only highlight the need to focus on Medicare disparities.  Five million seniors, or 10% of older adults, speak a language other than English at home.   Projections indicate that racial and ethnic minority elders will increase from less than 20% of the population to 40% by 2050, and Hispanic older adults will make up 20% of the senior population.

Recognizing the need of a growing population, and the severe implications of language barriers, it is important to target advocacy on ensuring language access in the Medicare Part D program. In recent years, NSCLC has worked with coalitions and partners to inform CMS about inadequate Medicare Advantage customer services agents and informational materials, and ensure a critical victory in CMS’ regulations regarding translation.

This advocacy is grounded in the fact that language access is a protected civil right. Executive Order 13166, “Improving Access to Services for Persons with Limited English Proficiency,” which implements title VI of the Civil Rights Act of 1964, requires any agency or entity that receives federal funds to take reasonable steps to ensure meaningful access to programs by LEP individuals.  With this mandate in mind, in 2007, the California Medicare Part D Language Access Coalition to look into concerns that Part D plans were providing inadequate customer service to LEP individuals.  Through a “secret shopper” survey of prescription drug plans in California, the Coalition found that plans’ call centers were failing LEP individuals.  For example, in test calls conducted by the coalition, the majority of plans did not connect the caller to a customer service representative who spoke the language of the caller.  Generally, these CSRs failed to provide information to the beneficiary in any language other than English.

In 2010, NSCLC found that many prescription drug plans were not publishing materials on their website in Spanish.  We looked at plans in Los Angeles and Miami, with large Spanish-speaking populations and found that, despite CMS marketing regulations requiring plans to post translated information, they were not meeting Medicare requirements.  These plans would aggressively market to Spanish speaking individuals, and then fail to provide them with the information they needed to make an informed choice about their care.  After sharing our research with CMS, the agency undertook closer surveillance of plans and now, two years later, most plans are in compliance with the regulation.  In addition, CMS has now created model translations of marketing documents in Spanish, in order to create uniformity and accuracy among plans.

Most recently, in 2011, language access advocates secured a critical CMS victory.  CMS proposed to set a requirement that plans translate marketing materials into any language that is the primary language of at least ten percent of the individuals in the plan service area.  Unfortunately, this requirement would have done little to break down language barriers, as it would have only required Part D plans in 10 states to translate materials into Spanish and would not have required translations into any other language.  In a rare advocacy moment, language access advocates managed to overwhelm CMS with comments on the issue, and push for a lower threshold.  CMS responded to the advocates by adopting a lower, five percent threshold.  The new regulation set an important precedent for Part D translations but more needs to be done.  We need to have a wider range of documents covered by the rule.  And we need regulations that reflect numbers of individuals, not just percentages, something that is particularly important in large states.  But it is a hugely important beginning.

For those of you who are following the dual eligible demonstration projects, you may notice that advocates have been very vocal about ensuring that plans in the demonstration provide culturally and linguistically appropriate services.  45%, or half, of Hispanic Medicare beneficiaries are dual eligible individuals, meaning they receive both Medicare and Medicaid services.  So far, CMS’ guidance and the state and federal agreements have included strong language about linguistic and cultural competence, and we continue to inform CMS and state advocates about the importance of language access in the duals demonstration.  We are pleased to see the commitment to language access but know that we need to work hard to ensure that those policy commitments turn into concrete actions.

We look forward to continuing the discussion on this important issue.