A 50-State Review of Access to State Medicaid Program Information for People with Limited English Proficiency and/or Disabilities Ahead of the PHE Unwinding

Issue Brief
  1. Two states (AZ, FL) require callers to enter identifying information in order to access live assistance and were excluded from this assessment.

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  2. If the PDF application could not be found on the homepage or online application landing page, this indicator was coded as “no” even if a PDF application was available elsewhere online. PDF applications vary widely in length, ranging from 9 to 62 pages.

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  3. Salame, R. (2021, April 30). Limited English Skills Can Mean Limited Access to the COVID-19 Vaccine. Slate. https://slate.com/news-and-politics/2021/04/covid-19-vaccine-for-non-english-speakers.html.

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  4. Taira, et al. (2021). A Pragmatic Assessment of Google Translate for Emergency Department Instructions. Journal of General Internal Medicine, 36(11), 3361-3365. doi: 10.1007/s11606-021-06666-z.

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  5. We did not assess the availability of live multilingual call center assistance.

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  6. We were unable to assess this indicator for online application forms because most states require users to create an account before accessing the contents of the online application.

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  7. Conversation with Jared Smith, Program Manager, Institute for Disability Research, Policy and Practice, Utah State University (June 7, 2022).

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  8. Id.

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  9. AK lacks an online application page.

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  10. State websites often include a brief description of TTY services explaining how the service is “designed for people who are Deaf or Hard or Hearing” (NC). For example, North Carolina’s website describes how the “relay operator reads aloud the message [the caller] typed to the other party and types the other party’s voiced message and background sounds, if any, to [the caller].” To see more about how TTY numbers can be used, see North Carolina’s infographic.

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  11. If the TTY number could not be found on the homepage or within one click from the homepage, this indicator was coded as “no” even if the number was available elsewhere on the website.

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  12. Two states (AZ, FL) require callers to enter identifying information in order to access live assistance.

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Appendix
  1. 42 C.F.R. § 435.905 (a).

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  2. 42 C.F.R. § 435.906.

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  3. 42 C.F.R. § 435.907 (a).

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  4. 42 C.F.R. § 435.908 (a).

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  5. Nondiscrimination in Health and Health Education Programs or Activities, Delegation of Authority, 85 Fed. Reg. 37,160 (June 19, 2020) (to be codified at 42 CFR Parts 438, 440, and 460).

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  6. 42 C.F.R. § § 435.905 (b)(1); 435.908 (a).

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  7. 42 C.F.R. § 435.905 (3).

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  8. Id.

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  9. 42 U.S.C. § 12131; 28 C.F.R. § 35.130 (accord Rehab. Act §  504 and ACA § 1557).

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  10. Id.

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  11. 28 C.F.R. § § 35.130; 35.164.

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  12. 28 C.F.R. § 35.101.

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  13. 28 C.F.R. § 35.160.

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  14. 28 CFR § § 35.104; 35.160.

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  15. 28 C.F.R. § 35.161.

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  16. Id.

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  17. 42 C.F.R. § § 435.905 (b)(2); 435.908 (a).

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  18. 42 C.F.R. § 435.905 (3).

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