Half of the non-English speaking people enrolled in a California healthcare plan reported they could never get a medical interpreter when they needed one, according to a survey conducted by San Francisco State University.
The program, Cal MediConnect, is an all-in-one pilot managed care plan that serves people who are eligible for both Medicare and Medi-Cal. An initial three-year demonstration program that runs through Dec. 31, the plan covers medical, prescription drugs and other long-term services, linking enrollees to providers within the plan’s network.
The program is available in seven California counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara. While it is not available in Sacramento County, a new statewide medical plan called CalAim that proposes to move all 1.2 million eligible Californians into the Medi-Cal managed care will build on what works well in Cal MediConnect.
The Department of Health Care Services will implement a broad delivery system and payment reform across the Medi-Cal program and apply it to all 58 counties in 2023.
But survey respondents have found interpretation services with the Cal MediConnect plan ineffective.
More than 40 percent of the program’s enrollees with limited English proficiency responded in the survey that it was harder to get an interpreter in 2017 than it was a year ago when they used Cal MediConnect services.
Another survey conducted by the Scan Foundation shows up to 40 percent of Asian and Pacific Islander enrollees indicated that their doctor or provider did not speak their language, or an interpreter was not available in 2018, as compared to 9 percent of Hispanic enrollees. Hispanic and Asian and Pacific Islander enrollees were the least likely to be “very satisfied” with their ability to call a health provider, regardless of the time of day, according to the survey.
“Our experience in Cal MediConnect can be used to predict where potential language access barriers might be in this new model ‘CalAim’,” said Denny Chan, senior staff attorney at Justice in Aging, a national nonprofit that fights senior poverty through law. “Sooner or later, this will affect all duals across California. The agencies want to move people to managed care plans across the state, so it is important for us to make sure these problems don’t continue.”
The issues with communications between physicians and patients are multifaceted, said Esther Lara, a medical social worker who works with patients over age 65 at the UC Davis Health Alzheimer’s Disease Center.
Many seniors in minority communities tend to be under-diagnosed if an interpreter is not present to translate, Lara said. Often they don’t come in with family members or a caregiver, or the caregiver is not included in the conversation. It is important for the patient to have someone who can verify information and make sure he or she understand and can carry the information home, so the caregiver can later read it and note the potential side effects.
The right to language access services is “enshrined in federal and state laws,” Justice in Aging stated in a letter addressing the department on Oct. 28.
While state agencies have done timely access surveys on Medi-Cal medical providers and call center staff members on whether they are aware of the rights to language access services for enrollees, Chan said they have yet to survey Cal MediConnect beneficiaries.
“The evaluation data (for Medi-Cal) tell us this is a problem. The state has an obligation to understand the barriers (of Cal MediConnect) and work on the policies on what to improve,” Chan said.
The Department of Health Care Services is not planning to conduct a timely access survey of Cal MediConnect providers, according to the department’s response to The Sacramento Bee’s inquiry.
The reply further stated a team of state and federal staff will work to resolve issues in response to complaints on access to care. The team will provide technical assistance on providing interpretation services and require plans to update and submit their respective interpreter policies and procedures.
Call centers are the critical connection point between healthcare providers and patients to ensure they get set up with timely medical services, Chan said, so it’s crucial for call center staff members to know patients’ rights to language access and schedule interpretation services before the appointment.
“(Enrollees) are likely have to make important decisions on your healthcare – whether you need to delay treatment, how regular do you have to take a drug, money – these are important details people want to know. And even one detail makes a difference,” Chan said.