Language barrier may prevent Medicaid enrollment

While those who work with government programs such as Medicaid often complain about the bureaucratic language used in regulations, manuals, and other documents, researchers have found that a more fundamental language problem may stand in the way of people enrolling for the benefits to which they are entitled — unfamiliarity with English.

"In comparing the populations of children who are enrolled in Medicaid with those who are eligible but not enrolled, we found the most significant difference was language related," Chyongchiou J. Lin tells State Health Watch. Ms. Lin is assistant professor of health services administration at the University of Pittsburgh Graduate School of Public Health.

Among Medicaid-eligible children, 29% of Hispanics were uninsured, compared with 19% of whites, 17% of African-Americans, and 12% of Asian-Pacific or others. Of the nonenrolled eligible Hispanics, 75% chose to be interviewed in Spanish, Ms. Lin reports, suggesting that difficulty with the English language may be responsible for nonenrollment.

Many not fluent in English

"While we cannot say definitively that the parents of eligible children not enrolled in Medicaid do not speak English, the study results do show that a significant number of individuals in this group feel more comfortable communicating in Spanish," she says. "Because Medicaid enrollment applications are fairly complicated, it is possible that someone with a limited ability to speak English would also have a limited understanding of the enrollment procedure."

Funded by the Robert Wood Johnson Foundation of Princeton, NJ, the study analyzed data gathered by the Center for Studying Health System Change’s 1996-97 Community Tracking Study Household Survey, eligibility data from state Medicaid programs, and the 1999 Area Resource File.

The review of 13,168 families with children under age 21 in 60 randomly selected communities found that approximately 23% of the children were eligible for Medicaid, with 48% of those eligible having Medicaid coverage, 35% with private or other health insurance, and 17% with no coverage. Compared to children enrolled in Medicaid, a higher proportion of uninsured Medicaid-eligible children were located in the South and West regions of the United States, lived in two-parent families, lived in families with income below the federal poverty level, and were Hispanic Americans.

"More than 25% of the families surveyed have employer-sponsored health insurance but are not taking advantage of it, and they are not enrolling their children in Medicaid," Ms. Lin says. "Single parents are more apt to seek out social services such as Medicaid for their children."

Ms. Lin cannot explain why children living with a single mother are more likely to be enrolled in Medicaid than those living in two-parent families, but she speculates that it could be because single women do not feel as secure and have less financial resources.

Compared to children enrolled in Medicaid, a higher proportion of uninsured Medicaid-eligible children reported no hospital stays, no doctor visits, no surgeries, unmet medical needs, and postponement of medical treatment, while a smaller proportion of them reported mental health visits and a doctor’s office as the usual source of care.

A companion study looked at baseline characteristics of children who would be presumptively eligible for the State Children’s Health Insurance Program (SCHIP). Among all children in the study sample under age 21, approximately 15% were thought to be SCHIP-eligible, with 25% of them not having any health insurance coverage.

Uninsured parents, kids

"If the parents are uninsured, then the children are more likely to be uninsured, especially if they have no access to employer-sponsored health insurance," Ms. Lin explains. Those without coverage also were more likely to live in the South and West, live in families with incomes less than the federal poverty level, and be Hispanic Americans. Again, a higher percentage of Hispanic families with uninsured SCHIP-eligible children were interviewed in Spanish

A higher proportion of the SCHIP-eligible children reported limitation in moderate activities and postponement of medical care, while a smaller proportion of uninsured SCHIP-eligible children reported at least one hospital stay, one doctor visit, one surgery, home health visits, and a doctor’s office as the usual source of care.

Ms. Lin says that as states crank up outreach efforts seeking to enroll eligible children in Medicaid and their CHIP programs, it will be important for them to understand the potential barriers and realize that it may be necessary to work in different languages when there are large populations who use English as a second language.

Contact Ms. Lin at (412) 624-3625.