1. Promoting Language Access, Health Literacy and Cultural Competency to Improve Health Equity Sarah de Guia, Executive Director Institute Of Medicine, Roundtable on Health Policy Integrating Health Literacy, Cultural Competency, & Language Access Services October 2015

2. Together we’re stronger!

3. CPEHN’s Key Policy Areas

4. Presentation Overview California’s diversity shows why language access, cultural competency, and health literacy are key. Promoting change by: –Codifying language access standards –Engaging community to provide culturally appropriate notifications –Creating consumer-friendly prescription labels Concluding thoughts

5. Race/Ethnicity of Medi-Cal Enrollees Source: Medi-Cal Managed Care Performance Dashboard, September 2015 - http://www.dhcs.ca.gov/services/Documents/MMCD/September172015Release.pdf http://www.dhcs.ca.gov/services/Documents/MMCD/September172015Release.pdf

6. Limited English Proficient Population Enrolled in Medi-Cal English ProficiencyCovered by Medi-Cal Speaks English Very Well19.6% Speaks English Well26.8% Speaks English Not Well/Not at All34.7% Source: 2014 California Health Interview Survey

7. Race/Ethnicity of Covered California Enrollees Race/Ethnicity# of Enrollees % of Respondents to Race/Ethnicity Questions African American23,5202.4 American Indian Alaska Native 3,0800.3 Asian217,80022.3 Latino276,80028.4 Native Hawaiian/Pacific Islander 2,3200.2 White385,13039.5 Total Enrollment1,307,750- Source: Covered California Data Book, June 2015 - http://hbex.coveredca.com/data-research/http://hbex.coveredca.com/data-research/

8. Top Non-English Languages by Covered California Enrollees Spanish: 12.8% Chinese:3.6% Korean:2.0% Vietnamese:1.3%

9. Ability to Access Primary and Specialty Care by English Proficiency English Proficiency Difficulty Finding Primary Care Difficulty Finding Specialty Care Does Not Have Usual Source of Care Speaks English Very Well 5.4%13.7%18.7% Speaks English Well 6.6%8.7%20.4% Speaks English Not Well/Not at All 3.8%16.7%27.2% Source: 2014 California Health Interview Survey

10. Health Status by English Proficiency English ProficiencyFair or Poor Overall Health Speaks English Very Well15.9% Speaks English Well20.3% Speaks English Not Well/Not at All43.9% Source: 2014 California Health Interview Survey

11. Importance of Health Literacy, Language Assistance, and Cultural Competency Majority enrollees in Medi-Cal and Covered California are communities of color. Over one-third of enrollees are LEP. Communities of color and LEP patients face barriers to care and more health disparities.

12. Creating Language Access Standards: Overview of California Law Medi-Cal Program Translation Thresholds: 3,000 per county 1000 per zip code 1500 per contiguous zip code Interpretation Services: Anytime in any language Commercial health plans and insurers Translation Thresholds: based upon enrollment Interpretation Services: Any language during business hours Requires collection of demographic data

13. Creating Language Access Standards

14. Engaging Community as Experts in Culturally Appropriate Messages Advised the State on translations of Medi-Cal application Advised Covered Cal on marketing materials to communities of color Ongoing review of materials from state agencies

15. Furthering Community Engagement Key opportunities: Rapid response by organizations Involved in founding of Covered California Partnerships with legal organizations Legislative and Administrative wins Diversity provisions in Covered California Board Consumer workgroup (AB 1296) Notices are regularly reviewed by advocates Limitations: No funding, mostly volunteer work Notices are still very complex

17. Creating Consumer-friendly Prescription Labels Key opportunities Background data pointed to a crisis Committed leaders LEP concerns raised early on Legislative and Administrative wins Passage of SB 492 (Corbett) Inclusion of LEP focus and support to study the issue Passage of AB 1073 and new regs to review translations Limitations Reluctance to adopt standard instructions in English Strong industry, different culture

18. Next Steps Enforce current laws: Ensure plans and insurers are meeting current language access and data collection requirements. Engage consumers of color and LEP consumers: Create alternative methods for surveying LEP consumers about their needs and experiences. Develop a culturally appropriate workforce: Better address cultural competency through workforce opportunities and needs. Utilize community partners: Work directly with communities to develop materials with culturally appropriate messages.

19. Thank you! For more information: Contact us at: (510) 832-1160 www.cpehn.org