Medicare Prescription Drug Plans Fail Limited English Proficient Beneficiaries

Executive Summary

Medicare prescription drug plans are required to provide multi-lingual services to Limited English Proficient (LEP) persons. Many beneficiaries have reported, however, that such services are unavailable. The California Medicare Part D Language Access Coalition, led by the National Senior Citizens Law Center, designed and conducted a survey to assess Medicare prescription drug plan call center service to LEP populations. This report summarizing the survey results identifies numerous shortcomings in plan performance, including that plans only serve LEP beneficiaries in their primary language 55% of the time, and only 37% for non-Spanish speakers.

Kendra Nicole Scalia 
NSCLC Health Policy Intern 
with the National Senior Citizens Law Center 
and the California Medicare Part D Language Access Coalition

ABOUT THE AUTHOR
 
Kendra Nicole Scalia has worked with the Oakland, California office of the National Senior Citizens Law Center since 2005, specializing on Medicare Part D issues. While at NSCLC, she designed and analyzed a 2006 survey entitled Prescription Drug Plans Often Wrong: Representatives Lack Training to Inform Medicare Beneficiaries of Plan Exception Procedures. Ms. Scalia is a 2007 candidate for the Master in Public Policy degree at the Goldman School of Public Policy at the University of California, Berkeley. 
ABOUT NATIONAL SENIOR CITIZENS LAW CENTER
The National Senior Citizens Law Center (NSCLC) advocates nationwide for the independence and well-being of low-income elderly people and others eligible for Medicaid, Medicare and Supplemental Security Income (SSI). The organization?s Oakland, California office has worked on Medicare Part D issues since the inception of the program. 
To learn more about NSCLC, visit us on the web at: www.nsclc.org
This survey was a joint project led by the National Senior Citizens Law Center in collaboration with National Health Law Program, National Immigration Law Center, California Immigrant Policy Center, PALS for Health and ALAS para Tu Salud, Neighborhood Legal Services of Los Angeles, and the California Medicare Part D Language Access Coalition, a broad group of advocates in legal and community based organizations serving Limited English Proficient (LEP) and low-income communities in California. 
Volunteers from the following organizations contributed extensive time and energy to the survey by completing calls: Asian Pacific American Legal Center, Bay Area Iranian Parents Group, Bay Area Legal Aid, Cambodian Community Development, Inc., Client Center for Health Education & Advocacy, Coalition for Humane Immigrant Rights of Los Angeles, East Bay Community Law Center, Filipinos for Affirmative Action, Health Rights Hotline, Korean Resource Center, Legal Assistance for Seniors, Neighborhood Legal Services of Los Angeles, PALS for Health and Southeast Asian Resource Action Center. 
Special thanks to Randy Boyle and Doreena Wong of National Health Law Program, Nancie Le of Neighborhood Legal Services of Los Angeles, Sonal Ambegaokar of the National Immigration Law Center, Kevin Prindiville, Georgia Burke and Katharine Hsiao of the National Senior Citizens Law Center for their coordination and editing assistance; to Heng Foong of PALS for Health and Cary Sanders of the California Immigrant Policy Center for their assistance in locating volunteer callers; and to Hemi Kim of the Asian Pacific Islander American Health Forum, Caroline Lee of the Korean Resource Center, Isabel Alegria of the California Immigrant Policy Center and Wingshan Lo of the Asian Pacific American Legal Center for their assistance with publicity. 
The author also extends gratitude and appreciation to Nina Talley-Kalokoh and Ken Lau for their support and contribution to the cumbersome task of survey evaluation collection and data entry. 

 

EXECUTIVE SUMMARY 
 
Medicare prescription drug plans are required to provide multi-lingual services to Limited English Proficient (LEP) persons. Many beneficiaries have reported, however, that such services are unavailable. The California Medicare Part D Language Access Coalition, led by the National Senior Citizens Law Center, designed and conducted this survey to assess Medicare prescription drug plan call center service to LEP populations. Because hundreds of thousands of California?s low-income dual eligibles (individuals with Medicaid and Medicare) are Limited English Proficient, the survey covers the sponsors of the nine prescription drug plans into which dual eligibles are automatically enrolled. The survey placed a total of 417 telephone calls in eleven of the thirteen most common languages spoken by LEP dual eligibles in California. Results of the survey indicate that plans are falling significantly short of meeting their obligation to provide interpretive services to all LEP beneficiaries. 
The market-based design of the Medicare prescription drug program (known as Part D) expects beneficiaries to operate as educated consumers when making difficult choices about coverage. In order to make wise choices, beneficiaries must have ready access to information. Whether shopping for a Medicare prescription drug plan or trying to access benefits, beneficiaries must be able to obtain information directly from Part D plans regarding cost-sharing, drug coverage, pharmacy networks, exceptions and appeals, and more. Without this information, the beneficiary is left stranded in an extremely complex environment, unable to understand and obtain the full benefits of the program. 
Recognizing that all beneficiaries must have access to information, the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare prescription drug program, requires that the call centers of participating plans provide language services to LEP beneficiaries. 
The ability to obtain linguistically appropriate information is particularly important for individuals who qualify for both Medicare and Medicaid (dual eligibles). Dual eligibles are the sickest and poorest Medicare beneficiaries. They are also more likely to be Limited English Proficient than other Medicare beneficiaries. Almost 30% of the approximately one million dual eligibles in California are Limited English Proficient. 
Key Findings 
 
  • Plan sponsors are only able to serve Limited English Proficient dual eligible beneficiaries in their primary language 54.7% of the time. 
  • Non-Spanish speaking LEP beneficiaries have even less success communicating with their plans. Plan sponsors are only able to serve non-Spanish speaking Limited English Proficient dual eligible beneficiaries in their primary language 36.6% of the time.
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