Lost in translation: Information for Medi-Cal’s beneficiaries

A photo illustration of language diversity. (Image: Lonely Walker, via Shutterstock)

For most patients, interpreting medical information can feel like interpreting a new language – the jargon and industry language requires reading comprehension comparable to the SATs. But imagine if that challenge also included interpreting mistranslated language. What’s a health consumer to do?

AB 318 (Chu) seeks to ease that for Medi-Cal consumers. The bill made it through the legislature, now Governor Newsom must sign it.

Asian Health Services (AHS), a clinic in Oakland providing health, social, and advocacy services, is at the front lines of medical communication confusion. Much of the clinic’s work involves translating the translations of medical information to patients. “88 percent of our patients are limited English speakers, and 25 percent geriatric,” says Dr. Huong Le, Chief Dental Officer at AHS. “Everything has to be translated in our health center.”

Many of the translated materials Medi-Cal patients receive are not culturally appropriate for the populations they are supposed to inform

The time Dr. Le’s staff spends translating materials that have already been translated gives them less time to see patients. “We spend about five to ten minutes at each visit – typically a 30-minute appointment, doing additional translation. It’s about 10-15 percent of our time with patients.”

Medi-Cal is one of California’s most complex programs; to access health care services, beneficiaries must understand a multitude of program rules. Making the program even more complex is the fact that English is not the primary language for more than one third of Medi-Cal beneficiaries, and they are more likely to have less reading and health literacy than English-speaking patients. Many of the translated materials Medi-Cal patients receive are not culturally appropriate for the populations they are supposed to inform, and often are not reviewed by native speakers, so translations end up overly academic, in the wrong dialect, or left with portions still in English.

These issues limit effective communication between healthcare providers and patients who need to access their benefits.

AB 318 would require the Department of Health Care Services (DHCS) to field test Medi-Cal materials, and require Medi-Cal managed care plans to field test materials they translate; the field tests would be conducted by native speakers, through internal translation focus groups or outreach from community organizations. The requirement would make medical information language plain, simple, and culturally appropriate — significantly increasing healthcare access for all Medi-Cal beneficiaries.

When translations don’t make sense to the people who need them, it not only wastes time and resources, it also endangers patients.

The bill also requires DHCS to consult with a readability expert to improve Medi-Cal documents and train staff on ways to make documents understandable for everyone, since even people whose first language is English have a hard time with some Medi-Cal documents.

AB 318 is a product of regular reports from local legal aid services across the state that Medi-Cal consumers often misunderstand critical information, even though current law says DHCS must require Medi-Cal managed care plans to provide translations. When translations aren’t field tested, the resulting translated plan materials are often completely inaccessible for the intended audience.

Field review processes for Medi-Cal managed care materials are not new. Some plans already have community reviews of materials, and Covered California included community review in its most recent translation contract.

Many county behavioral health programs also deploy native speakers to review and test translations for clients accessing mental health and substance use services because they understand the critical and sensitive nature of clear communication. According to the County Behavioral Health Directors Association, the cost to this approach is low, but the benefit is significant since it increases access to preventive services in communities that have long faced significant barriers to care. AB 318 would establish that standard statewide.

When translations don’t make sense to the people who need them, it not only wastes time and resources, it also endangers patients. Dr. Le and her colleagues at AHS are particularly aware of the importance of correct translation for effective communication with patients, “We always talk about consent and communication, and really the key to good communication between provider and patient is the full understanding of what’s about to be done. If it’s not there because the language is confusing or the translation isn’t accurate, there could be unintended consequences.”

Medi-Cal beneficiaries don’t all have access to clinics with language resources like those available at AHS, so California needs a solution that will benefit the whole state and a diversity of communities.

AB 318 is a common sense fix to a problem that shouldn’t exist. Governor Newsom must sign the bill to take a fundamental step toward creating a California health care system that works for all.

Ed’s Note: Jen Flory is a health policy advocate at Western Center on Law & Poverty. Kiran Savage-Sangwan is the executive director of the California Pan-Ethnic Health Network.

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