Addressing Gaps in Access: Examining Language Barrier Accommodations in Medicaid Member Handbooks, 2015-2019

Objective: This study examines the linguistic accessibility of Medicaid Managed Care Organization (MCO) handbooks from 2015 to 2019 by analyzing the instructions provided to access interpreter and written translation services. Trends were compared over time, considering state and plan-level factors that impact equitable healthcare access for Limited English Proficiency (LEP) enrollees. Methods: A systematic search using manual efforts and FOIA requests located all publicly available Medicaid handbooks from 2015-2019 (N=657) across 39 states with comprehensive MCO plans. These handbooks were coded by independent reviewers to assess the study outcome variables. Random mixed-effects logistic and linear regression models were conducted to analyze factors associated with LBA, including handbook characteristics, state-level factors, and MCO-plan factors. Results: From 2015 to 2019, MCO handbooks providing non-English interpreter service instructions rose from 50.42% to 91.07%, while those offering non-English written translation service instructions increased from 62.75% to 90.10%. The average number of non-English languages offered also increased from about four to 14, with these instructions increasingly being placed in more accessible locations of the handbook. Accommodations were more likely in Medicaid expansion states and large-enrollment plans, but less likely in for-profit MCOs, higher LEP states, and mixed-partisan states (p< 0.05). Conclusions: Although language barrier accommodations have improved nationally, values for these measures indicate remaining gaps for millions of enrollees. Stronger policy efforts are needed to expand language accessibility and reduce disparities in healthcare access, particularly for diverse linguistic states with a large LEP population.