By Rachel Showstack and Rommy Vargas-Bezzubikoff*
As linguistically diverse Kansans have proclaimed at community meetings across Kansas and even on video, improving healthcare interpreting services is a key step toward ensuring that every Kansan has an opportunity to achieve their highest possible level of health.
Improving healthcare language access is a complex challenge because it requires workforce development, dissemination of resources to healthcare entities, enforcement of regulations, optimization of funding systems, and implementation of community education programs. It also involves multiple interested groups, including patients who need to communicate in a language other than English, state and local health departments, healthcare administrators, interpreters and interpreter trainers, healthcare workers, and healthcare worker educators.
At the Language Access Policy Summit that took place in Topeka on October 16, several of these groups participated in conversations about the challenge of providing qualified healthcare interpreting in Kansas and the steps needed to improve services. The summit was organized through a collaboration between El Centro de Topeka, Wichita State University faculty, and Alce su Voz to explore ways to improve the state system for supporting adherence to federal regulations. It was an important step toward building statewide coalition to concretize and implement the next steps.
As we have explained in this blog previously, failure to provide qualified language access services in health care is against the law. Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act provide strong protections against discrimination based on language in any entity that receives federal funds which includes most healthcare entities, as well as in federally run programs and activities.
In Kansas, Medicaid Managed Care Organizations (MCOs) provide interpreting services for the individuals they cover. The three MCOs that currently administer Kancare (the state’s Medicaid system), Sunflower, Aetna, and United Health Care, offered information at the summit about their systems for ensuring the provision of language access to users.
Despite the availability of interpreting services provided by the MCOs, many healthcare entities in Kansas do not utilize those services, perhaps because the personnel are not aware of them. In some cases, they also call on bilingual medical staff, such as medical assistants, to provide interpreting services, even if those staff members have not received interpreter training. Sometimes bilingual staff must fulfill a dual function, doing their own work and the interpretation.
Furthermore, the MCO services do not cover individuals living in Kansas without medical coverage. In rural parts of the state, patients not covered under Medicaid who require interpreting services have been denied care due to the unavailability of interpreters.
Problems like these are more likely to occur when healthcare entities lack Language Access Plans, written plans for how they will provide language access services. Such plans will become increasingly important as the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services moves to finalize a new set of proposed regulations for nondiscrimination in health programs and activities this December.
Mara Youdelman, the Managing Attorney at the Washington Office of the National Health Law Program, attended the summit and presented a summary of these proposed regulations, offering recommendations on how the state can support improved services. The proposed regulations include a refined definition of “qualified interpreter,” expanded language access service requirements and responsibilities of covered entities, and expectations for training staff about language access policies and procedures.
Ms. Youdelman recommended that the state work to improve healthcare language access through a four-part strategy that includes education, outreach, implementation, and enforcement. In the areas of education and outreach, MCOs can provide members with information about their rights and how to access language services, and healthcare institutions can display and distribute materials to support communication about language access.
The state can also ensure that providers are complying with federal laws though ongoing education for all staff on providing covered services. Topics should include patients’ rights, providers’ responsibilities, who to call for language assistance, what could happen if language assistance is not requested, how to provide culturally responsive care, and how to work with an interpreter. In addition, the state can work to ensure that the appropriate trainings are available for interpreters.
Enforcement can include regular thorough assessment of language access services. It goes without saying that if assessment includes patient surveys that the surveys must be translated into multiple languages.
Representatives from the Kansas Department of Health and the Environment (KDHE) participated in the summit and expressed a commitment to the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Healthcare, which provide a framework for adhering to federal language access regulations.
In anticipation of the release of a request for proposal (RFP) for new contracts or renewal of contracts for the MCOs, KDHE held several public input sessions in summer 2023. A report on the public commentary indicates that stakeholders highlighted the importance of improving access to interpreting services, especially in rural areas. In response to this commentary, the RFP includes access to interpreting services as an enhanced requirement to support KanCare program improvement.
Wichita State University faculty and the Alce su Voz leadership look forward to collaborating with KDHE in the future to improve healthcare language access services across the state.
NHeLP’s Section 1557 Resources
*Rachel Showstack (PhD) is an Associate Professor of Spanish at Wichita State University and Rommy Vargas-Bezzubikoff is the Alce su Voz Director of Interpreter Engagement and Education and Founder and President of Spanish Ad Hoc Translations, LLC.
Alce su voz is a community-based coalition whose mission is to improve health equity for Spanish speakers and speakers of indigenous languages in the United States, with a focus on Kansas and the Midwest. Our current programs are funded by federal and foundation grants attained by Wichita State University and the Wichita State University Foundation for interdisciplinary projects housed within the Department of Modern and Classical Languages and Literatures. For more information or to get involved, please send an email to alcesuvoz@gmail.com. You can also join our email list and follow us on Facebook.
This blog post was supported by the Office of Minority Health (OMH) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $375,000 with 100 percent funded by OMH/OASH/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor endorsement by OMH/OASH/HHS, or the U.S. Government. For more information, please visit https://www.minorityhealth.hhs.gov/
You can read this post in Spanish here.
