Medicaid
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Dear County Executive: close gaps in the Medicaid application process for Limited English Proficient residents

September 13, 2022
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By: Elaine Tso, Asian Services in Action (ASIA)

Dear County Executive,

Asian Services in Action (ASIA), supports immigrants and refugees with various resources, including government benefits. We guide immigrants and refugees through the American system to help them apply for eligible programs and benefits that would improve their life in the United States, such as Medicaid. Access to affordable healthcare is a basic human need. Medicaid helps our clients afford their other basic needs such as food and shelter, especially for families who are low- to medium-income.

ASIA helps several hundred Limited English Proficient clients per year apply for Medicaid so that they have access to affordable health insurance coverage.

ASIA helps several hundred Limited English Proficient (LEP) clients per year apply for Medicaid so that they have access to affordable health insurance coverage. Even when they are eligible for this benefit, several barriers complicate application process which can delay or deny them the Medicaid that they need. The application process for Medicaid must be linguistically and culturally accessible for all applicants. The biggest barriers for immigrant and refugee applicants are language and comprehension. ASIA serves clients in many languages, including Cantonese, Nepali, Burmese, and Pashto, which reflects the diverse communities of Cleveland. English proficiency for ASIA’s clients is limited, especially for those who are above the age of sixty-five. Currently, the Medicaid application form is only available in English and Spanish, which limits the populations of people who can submit an application on their own. Job & Family Services phone interpreters may be available in Mandarin, but not in the other dialects of Chinese that are predominant in Cleveland’s Asiatown, such as Cantonese or Taishanese.

Many clients, therefore, depend on an Authorized Representative to apply and speak on their behalf. The process of applying for an Authorized Representative, however, is unclear. The Medicaid application form designates a section for identifying an Authorized Representative, yet gives no indication that Cuyahoga County requires a separate form. Applicants might go through the entire application process, only for their application to bounce back because they were not aware that they needed a separate form.

Applicants might go through the entire application process, only for their application to bounce back because they were not aware that they needed a separate form.

Also challenging is the application’s assumption that applicants have the same understanding of required forms, information, and the process as Jobs & Family Services’ staff. Medicaid requires applicants to include pay stubs or tax filing information, which are concepts less prevalent outside of the United States. Questions about Social Security numbers, retirement income vs regular income, who constitutes as a household member, etc. require a background knowledge of these technicalities to answer application questions correctly. New immigrants do not have the basic understanding these forms and phrases that the application takes for granted and struggle to answer accurately.

The application process also places the burden on the applicant to conduct follow-up calls without sufficient instructions. LEP residents already need an average of two hours to begin to complete the application. If the application requires additional or corrected paperwork, Jobs & Family Services does not inform the applicant. Instead, applicants are expected to call the office to check on the status of their form before anyone might tell them if something is missing, or if the application was received at all. Our community members, therefore, have to navigate an unfamiliar procedure, via the Jobs & Family Services phone line that can have a waiting time of over an hour. Clients with a limited understanding of the language and system can be left in an application status limbo waiting to connect with a Jobs & Family Services agent. Furthermore, if more than 45 days passes, their application expires and they must start over.

The Medicaid application process needs improved and streamlined so that more eligible community members to efficiently and successfully apply. Clearer and comprehensive instructions, access to broad language-appropriate tax services, and simplified requirements would help more Ohio residents to apply for the necessary health insurance, for which they are eligible.

Medicaid provides healthcare coverage for many LEP community members. ASIA has clients who travel two hours to our Cleveland office for the sole purpose of applying for Medicaid with our help, otherwise they have no way of knowing how to apply. Seniors who must apply yearly dread the annual application for Medicaid because of its complicated process. The Medicaid application process needs improved and streamlined so that more eligible community members to efficiently and successfully apply. Clearer and comprehensive instructions, access to broad language-appropriate tax services, and simplified requirements would help more Ohio residents to apply for the necessary health insurance, for which they are eligible.

Cuyahoga County is home to a diverse community that includes immigrants and refugees who built neighborhoods and grew the economy.

Facilitating access to affordable healthcare coverage through Medicaid and other programs welcomes the newly arrived community who will return on this investment in them for a healthier population.

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