Texas Health Institute: Implementing Cultural and Linguistic Requirements in Health Insurance Exchanges

This comprehensive policy analysis from the Texas Health Institute examines the cultural competency and linguistic access requirements for health insurance exchanges, or marketplaces, being established through the Patient Protection and Affordable Care Act (ACA).  There are eight provisions in the ACA with specific requirements for cultural and linguistic appropriateness as well as non-discrimination and disparities reduction in health insurance exchanges and health plans:

1. Section 1311(b): Establishment of State Exchanges
2. Section 1311(i): Culturally, Linguistically Appropriate Information in Exchanges
3. Section 1311(e): Plain Language Requirement for Health Plans
4. Section 1001: Culturally, Linguistically Appropriate Summary of Benefits and Uniform Glossary
5. Section 1001: Culturally, Linguistically Appropriate Claims Appeals Process
6. Section 1311(g): Incentive Payments in Health Plans for Reducing Disparities
7. Section 2901: Remove Cost Sharing for Indians below 300 Percent of the Federal Poverty Level
8. Section 1557: Non-Discrimination in Federal Programs and Exchanges

The report also provides case studies from seven state-based exchanges (California, Colorado, Connecticut, Maryland, New York, Oregon, and Washington) on how these provisions are being implemented, as well as other activities to address the cultural and linguistic diversity of residents in those states expected to purchase health insurance through the exchanges.

The report concludes with the following recommendations, based on the case studies and interviews with key stakeholders:

1. Fully integrate diversity and equity objectives in exchange mission, objectives, and planning.
2. Work with trusted advocates and representatives who are reflective of diverse communities and are culturally and linguistically competent to provide appropriate and targeted outreach, education, and enrollment in the exchange.
3. Ensure culturally and linguistically appropriate information, resources, and communication is provided by the exchange.
4. Actively share and disseminate information on experiences, promising practices, and lessons learned in addressing diversity and equity in exchange planning.
5. Use active purchasing to ensure good value and high quality in health plans sold through the exchange and a reasonable number of choices at each benefit level.

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