April 2001
According to the March 2000 Current Population Survey published by the U.S. Census Bureau, 42.5 million individuals (15.5% of the U.S. population) did not have health insurance for the entire year of 1999. Racial and ethnic minorities were found to be particularly vulnerable to being uninsured. Asian Americans and Pacific Islanders (AAPI) were almost twice as likely to be uninsured (20.8%) compared to non-Hispanic Whites (11.0%). AAPI children also continue to have higher rates of uninsurance (16.7%) compared to non-Hispanic White children (8.9%).
Two major Federal programs designed to reduce the number of uninsured are Medicaid and the State Children’s Health Insurance Program (SCHIP). Both of these programs have recently released final regulations that may have enormous impact on the Asian American and Pacific Islander population. These regulations were to take effect April 2001, when all states were to come into compliance. However upon taking office, President Bush signed an Executive Order to postpone for 60 days the effective date of all regulations published in the last 60 days of the Clinton Administration. It is still unclear at this time how the Administration is planning to proceed with these regulations. APIAHF, along with other national advocacy organizations, has urged the Bush Administration to implement the regulations as they were published and without further delay.
New SCHIP Regulations on Race, Ethnicity, and Primary Language Reporting
The State Children’s Health Insurance Program (SCHIP), created by the Balanced Budget Act of 1997, provides funds to States to enable them to expand health coverage to uninsured, low-income children. By the end of Fiscal Year 2000, 3.3 million children had been enrolled as a result of the initiative. In November 1999, the Health Care Financing Administration (HCFA), responsible for administering SCHIP at the federal level, published proposed rules for implementing the program. The proposed rules did not require reporting of data on the gender, race, ethnicity or primary language of SCHIP enrollees. APIAHF, along with numerous other concerned organizations, provided comments to HCFA stressing the importance of information on how well SCHIP is addressing the needs of uninsured minority children.
HCFA announced the publication of the final rules for the program in the January 11, 2001 edition of the Federal Register. The final rules contained a number of important differences from the proposed rules (see Federal Register, November 8, 1999). Among the changes is a new requirement for States to collect data on gender, race, and ethnicity of SCHIP enrollees and report these data in their quarterly statistical enrollment reports to HCFA. Furthermore, data on primary language must be collected and included as part of a State's annual report. To view the final rule visit http://www.hcfa.gov/regs/hcfa2006fc/hcfa2006fc.htm.
Medicaid Managed Care Regulations Could Ensure Linguistic Access and Culturally Competent Care
HCFA also published final regulations for Medicaid managed care programs on January 19. The final regulations include detailed requirements for state Medicaid managed care plans to ensure linguistic access and cultural competency. For example, the regulations require each state to establish a methodology for identifying the non-English languages spoken by enrollees and potential enrollees; provide written information in each non-English language that is necessary for effective communication with a significant number or percentage of enrollees and potential enrollees; make written information available in the languages that are prevalent in its particular service area; make oral interpretation services available free of charge; notify enrollees and potential enrollees that oral interpretation and written information are available in languages other than English and how to access those services. The regulations also require similar language assistance in grievance and appeal procedures.
The final regulations also require identification of providers able to speak languages other than English and requires that each managed care organization and prepaid health plan ensure "that services are provided in a culturally competent manner to all enrollees, including those with Limited English Proficiency and diverse cultural and ethnic backgrounds." To view the final rule, visit http://www.access.gpo.gov/su_docs/fedreg/a010119c.html, then scroll down to "Health Care Financing Administration."
