Translating Health Traduciendo Salud T łumaczenia zdrowie

1. Translating Health TraduciendoSalud Tłumaczenia zdrowie Christina O. Foreman Policy Action Plan HPA 430

2. The Issue/Problem • Language barriers interfere with providing quality healthcare both in the acute setting and in the care of chronic conditions. • Latinos alone make up 16.7% percent of the population of the continental United States. This number continues to grow, with a 2.5% increase between 2010 and 2011 alone. • This impressive increase in only one ethnic group coupled with the exponential increase in demand expected to follow with the initiation of the Affordable Care Act (ACA) make adequate and quality translation services a necessity rather than an accessory component of our healthcare system and health services.

3. Data and Evidence • According to the 2007 Census, an estimated 20 million people (one in 15) in the United States speak and understand little or no English (Census, 2007). • Spanish: 67 million native speakers in the United States • 50% speak English “very well” • Polish: 40 million native speakers in the United States • 1 in 4 Medicaid enrollees is Hispanic • Medicaid alone covers nearly 40% of African American and Latino children. • The Affordable Care Act (ACA) is expected to cover an additional 32 million Americans of which racial/ethnic minority comprise more than 50%. • Medicaid is the largest government healthcare program • 1 in 4 Americans were on Medicaid at some point in 2012, including 30 million children • The Affordable Care Act (ACA) is expected to cover an additional 32 million Americans of which racial/ethnic minority comprise more than 50%. • 70% of physicians accept Medicaid patients. Medicaid pays 2/3 of what is reimbursed for Medicare patients, which is consistently lower than privately insured patients. Providers are not reimbursed the cost of providing translation services. • Translation services are required by law through Title VI of the Civil Rights Act of 1964 • In some states, providers can apply to receive partial federal reimbursement for translation services for Medicaid and SCHIP patients. This reimbursement can be up to 70-80% of the cost. It is not available for Medicare patients, and it is not available in the state of Illinois

4. Proposed Action Oriented Solution • Due to the crucial role that translation plays in providing quality healthcare to our non-English speaking patients, the proposed action is to include translation services used in the Healthcare encounter in the reimbursement for Medicare and Medicaid • This action would serve patients and encourage providers at every stage in this issue • If no system is in place  motivate/incentivize its strong development • If one is in the early stages  support it as a worthy continued investment for the future • If long-standing accommodations have been made  reward those endeavors/hold these systems up as models

5. Policy Entry Point: • The entry point would be at the state level, starting with the bicameral legislature of Illinois, stemming from the purpose and goals established for the Advisory Panel on Minority Health est in 1998 • 9(e) reads: that the role of the advisory panel is to assist in the “reduction of communication barriers for non-English speaking residents.” • Success and support at the state level would serve as a model and argument for implementation of such a plan at the federal level

6. Policy Paramours • These paramours are both political and civilian. They are groups, as well as, individuals, with a similar passion and dedication to the cause of Healthcare Disparities and Minority Health: • Illinois Legislative Latino Caucus • Minority and Latino and/or Spanish speaking congressmen and congresswomen • Within our State Legislature: Representative Davis and The House Committee of Health & Healthcare Disparities Committee of the House of Representatives • SalimAl Nurridin of the Healthcare Consortium of Illinois • Jennifer Arias of St. Jude Hospital and the Health & Healthcare Disparities Committee

7. Specific Proposed Language • To fulfill the goals set by the Disadvantaged Minority Health Improvement Act of 1990 (P.L. 101-527) and in accordance with the work of the 103rd US Congress in addressing Healthcare Disparities in regards to providing adequate linguistic services for patients, and in line with the mission and purpose of the Advisory Panel on Minority Health established into Illinois in 1998, I propose that reimbursement for translation services be recognized by Medicare and Medicaid in the state of Illinois.

8. Stakeholders • Ethnic groups • Hispanocare • Polish American Association • University and Chicago city groups: • UIC Hispanic Center of Excellence has played an integral role in helping Latino, Spanish-Speaking students achieve higher education especially in the field of medicine, understanding the critical role that Spanish speaking physicians play in addressing this issue. They have extended their solid support for this cause • UIC School of Public Health which champions and promotes not only education but action in regards to promoting Public Health and addressing issues of healthcare

9. Marketing Approach • Translating Health, TraduciendoSalud, Tłumaczenia zdrowie • Translating to patients of all languages is a vital and integral part of quality healthcare and health services • Including translation services in the coding and billing of Medicare and Medicaid is an act of recognition of our current population, both diverse and growing This action is rising to the need, assisting in the development, rewarding the unified efforts

10. Work Cited • Health Disparities and the Affordable Care Act - National... Available at: www.ncsl.org/documents/health/HDandACA.pd • Henry J. Kaiser Family Foundation. Health reform and communities of color: implications for racial and ethnic health disparities. September 2010. Report No. 8016-02 [cited 2010 Nov 2]. Available from: URL: http://www.kff.org/healthreform/8016.cfm • Language Use in the United States: 2007 - U.S. CensusBureau www.census.gov/prod/2010pubs/acs-12.pdf‎ • Office of Minority Health at cms.gov