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Presentation: 5:20


Limited English proficient (LEP) Pennsylvania Medicaid enrollees are at risk of being denied access to timely and effective healthcare services due to the inconsistent availability of qualified healthcare interpreter services (HIS) at all points of care within the Medicaid healthcare system. Lack of qualified HIS has been found to increase disparity in access, quality of care, and health outcomes for LEP individuals while increasing resource utilization and hospital readmission rates. In an effort to address the needs of their LEP populations, several state Medicaid programs have developed language access programs that include healthcare provider reimbursement for the cost of using HIS. The Pennsylvania Medicaid program does not provide standardized HIS reimbursement for all healthcare providers. This creates a cost burden for smaller healthcare practices, impacting LEP Medicaid enrollees’ access to services. The objective of this Capstone project was to develop policy provisions that will improve the timeliness, consistency, and quality of Pennsylvania Medicaid HIS. To inform this proposal, an analysis of the 12 states and Washington D.C. Medicaid programs with existing HIS reimbursement policies was conducted. Pennsylvania’s current Medicaid HIS policy was also evaluated. Four domains of the HIS policies were evaluated: administrative vs. covered claims, reimbursement mechanisms, quality assurance, and capacity. State Medicaid websites, managed care organization (MCO) contracts were the primary sources for collecting information. The analysis revealed that the predominant method of providing HIS is through MCO contractual requirements. There is limited data available regarding HIS request and usage rates. Some states have developed methods to increase HIS capacity and improve program quality. Recommendations for the Pennsylvania Medicaid HIS policy proposal include expanding current MCO HIS provisions, establishing MCO reporting mechanisms for HIS request and request fulfillment rates, and creating a stakeholder taskforce to oversee development of HIS standards, workforce recruitment, and healthcare personnel training initiatives.

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