CALIFORNIA HEALTH PLANS AND LANGUAGE ACCESS

7. Does the Health Plan provide notification to all members about free language assistance?

Health plans can help patients with language needs by making sure their members know that free language assistance is available to them if they need it. Although language can be a major barrier to accessing health care services, health plans can help by notifying members that a free interpreter is available to help them meet this challenge. This demonstrates to patients that the health plan is ready to work with them, and that the health plan recognizes that communication is central to staying healthy. Unfortunately, few health plans notify their members of free language assistance services.

Aetna US Healthcare	Blue Cross	Blue Shield	CIGNA HealthCare California	Health Net	Health Plan of the Redwoods	Inter Valley	Kaiser	Lifeguard	National Med	Pacifi-Care	Universal Health Care	Western Health Advantage
Yes	No	Unclear	No	No	In Develop-ment	No	Yes	Yes	Yes	No	Unclear	No

8. Does the Health Plan provide materials in non-English languages?

"Enrollment materials and presentations in a variety of languages are available to Plan members [who do not speak English well], including but not limited to Tagalog, Vietnamese, Japanese, and Spanish."
-Cigna HealthCare California

Health Plans can help patients overcome language difficulties by providing brochures and other materials in the languages spoken and read by their patients. Translating materials so that patients have something to read in their own language can help them feel more comfortable with their health plan and the care they receive. Some health plans do not translate any materials, or translate them into only one non-English language. In addition, some health plans translate only membership or marketing materials, while others also translate health education brochures, grievance forms, patient's rights information, and other patient education material that can be very valuable for members.

Aetna US Healthcare	Blue Cross	Blue Shield	CIGNA HealthCare California	Health Net	Health Plan of the Redwoods	Inter Valley	Kaiser	Lifeguard	National Med	Pacifi-Care	Universal Health Care	Western Health Advantage
Yes-Spanish	Yes-For some members	Yes-Spanish	Yes-Japanese, Spanish, Tagalog, Vietnamese	Yes- Chinese, Spanish	Yes-Spanish	Yes-Spanish	Yes-Chinese, Spanish	Yes- Unclear what languages	Yes-Spanish	Yes-Unclear what languages	Yes-For Some Members	Yes-Spanish

9. COMMITMENT TO CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICEs

"The members' preferred language is noted in the medical record and updated in the computer system."
-Universal Care

Health plans show their commitment to serving their members' needs in many ways. To demonstrate their commitment to diverse, multiethnic, and multilingual communities, some health plans assess the cultural and linguistic needs of the communities they serve, have a written policy on the provision of culturally and linguistically appropriate services, and provide trainings for doctors regarding these policies and how to respond to patients with cultural and linguistic needs. Some health plans also monitor complaints from patients that result from differences related to culture and/or language.

10. Does the Health Plan assess the cultural and linguistic needs of its members?

Health plans have to understand the needs of their members in order to serve them in an effective way. This means that health plans need to collect basic demographic information on its patient population, including cultural and linguistic needs. There are many ways that a health plan can do this kind of assessment; some methods will probably provide a more accurate picture of the plan's patient population than others. The better a plan is at being able to assess the cultural and linguistic needs of its members, the more likely it is to meet patient needs effectively.

Aetna US Healthcare	Blue Cross	Blue Shield	CIGNA HealthCare California	Health Net	Health Plan of the Redwoods	Inter Valley	Kaiser	Lifeguard	National Med	Pacifi-Care	Universal Health Care	Western Health Advantage
Yes	Yes	Yes	Yes	Yes	In Develop-ment	Yes	Unclear	Yes	No	Yes	Yes	Unclear

11. Does the Health Plan have a written policy about how to provide services for patients who do not speak English well?

Some health plans have already embraced the value of providing culturally and linguistically appropriate services, while others are just beginning to understand the importance of these values. A written policy on the provision of culturally and linguistically appropriate services can help to focus a health plan's commitment to serving diverse communities. The policy can provide a clear guideline for staff and providers to follow regarding what they should do when serving a patient with specific needs due to a cultural or language difference. The policy can also help the Department of Managed Health Care and other state and federal agencies to evaluate whether plans are complying with their own guidelines.

Aetna US Healthcare	Blue Cross	Blue Shield	CIGNA HealthCare California	Health Net	Health Plan of the Redwoods	Inter Valley	Kaiser	Lifeguard	National Med	Pacifi-Care	Universal Health Care	Western Health Advantage
No	For Some Members	Unclear	Yes	No	No	Unclear	No	No	Yes	Yes	Yes	Yes

"Universal Care provides consistent and on-going training to providers and staff so that they understand the Plan's [language access] policies. Universal Care disseminates… policy and procedures information to providers through…provider committee meetings, cultural diversity training, cultural competency training, medical interpretation training, [in addition to other methods]."
-Universal Health Care

12. Does the Health Plan conduct trainings for health care providers to ensure they understand the plan's policies and procedures for members who do not speak English well?

Having a cultural and linguistic policy can be a good start to making sure that patients receive appropriate services. However, regardless of whether there is a specific policy in place, providers need to be aware of the cultural and language needs of their patients, and know how to serve them. To help providers better prepare for patients with cultural and language backgrounds different from their own, some health plans offer special trainings. These trainings can show doctors effective ways of communicating with diverse patients, educate providers regarding specific cultural values, and demonstrate to doctors the proper way to work with interpreters.

Aetna US Healthcare	Blue Cross	Blue Shield	CIGNA HealthCare California	Health Net	Health Plan of the Redwoods	Inter Valley	Kaiser	Lifeguard	National Med	Pacifi-Care	Universal Health Care	Western Health Advantage
No	For Some Providers	Yes	No	For Some Providers	In Develop-ment	No	Unclear	No	No	No	Yes	No

13. Does the Health Plan monitor complaints specifically related to language barriers?

"[The] Blue Cross State Sponsored Programs division has a grievance process that monitors member complaints. The grievance system was updated in 2000 to capture any grievances or complaint codes of a cultural or linguistic nature."
-Blue Cross Health Plan

When patients are not satisfied with the services they receive, they should call the health plan or a consumer advocacy agency to make a complaint. Health plans should regularly monitor these complaints to identify areas for improvement. Some health plans claim to monitor complaints due to cultural or linguistic problems and identify these complaints separately from other grievances. Being able to track complaints based on the specific cause, such as culture and/or language, can help health plans see patterns and trends more clearly. Tracking complaints by the primary language and ethnicity of members can also highlight service needs for particular communities. In addition, specifically monitoring complaints related to culture and language shows that the health plan is committed to identifying these issues, and recognizes that cultural and linguistic concerns require special attention.

Aetna US Healthcare	Blue Cross	Blue Shield	CIGNA HealthCare California	Health Net	Health Plan of the Redwoods	Inter Valley	Kaiser	Lifeguard	National Med	Pacifi-Care	Universal Health Care	Western Health Advantage
No Response	For Some Members	No	Yes	Unclear	No	No	No Response	No	Unclear	Unclear	Yes	Unclear

14. What Should Patients Look For?

Choosing a health plan can be an important and complicated decision, especially for people who do not speak English well. To make the choice that is best for each individual and family, patients should learn about the cultural and linguistic services offered by each health plan. Some health plans are likely to offer services that are more appropriate for certain communities. For example, one health plan may have providers who speak Korean, while another may have providers who speak Armenian.

There are many things patients can look for when choosing a health plan. Below are some questions to ask health plans to make sure they provide the culture and language services you may need.

Does my health plan:

Give me an up-to-date list of health care providers who speak my language?
Provide free trained face-to-face interpreters when I need to communicate with a doctor who does not speak my language?
Provide free trained telephone interpreters during medical encounters when a face-to-face interpreter is not available?
Have information about the health plan and membership rights in my language?
Have patient education materials in my language?
Have a representative I can talk to that speaks my language when I have questions about my benefits or my bill?
Have a representative I can talk to that speaks my language when I want to make a complaint about problems I have with my provider or health plan?

If you feel you have been treated unfairly by your health plan, you can call the DMHC Hotline at 1- 888-466-2219 . The Hotline staff use Telephone Interpreters to assist patients, and can help to resolve problems between you and your health plan. You may also file a complaint with the Office for Civil Rights at 1-800-368-1019 if you feel you have been discriminated against because you do not speak English well, or because of your race, color, or national origin.

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