BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair


          AB 2392 (J. Perez) - Medi-Cal: interpreter services.
          
          Amended: May 25, 2012           Policy Vote: Health 6-3
          Urgency: No                     Mandate: No
          Hearing Date: August 16, 2012                          
          Consultant: Brendan McCarthy    
          
          SUSPENSE FILE.
          
          
          Bill Summary: AB 2392 would require the Department of Health 
          Care Services to establish a program to provide interpretation 
          services to Medi-Cal beneficiaries who have limited English 
          proficiency.

          Fiscal Impact: 
              One-time costs likely in the hundreds of thousands to 
              develop program guidelines, seek necessary federal 
              approvals, and develop billing systems.

              Ongoing costs of about $30 million per year to provide 
              translation services in fee-for-service Medi-Cal.

              Unknown costs in Medi-Cal managed care. Under current law, 
              health plans are required to provide interpretation 
              services, including managed care plans that contract with 
              the Department of Health Care Services. It is unclear 
              whether the bill's requirement to provide "certified medical 
              interpretation services" would increase costs for 
              translation services, above the costs already being 
              incurred.

              The federal financial participation rate for the costs 
              above may vary. For interpretive services provided to 
              children and their family members, the state can claim a 75% 
              federal financial participation rate. However, those costs 
              are only eligible for a 75% federal cost share if they are 
              billed as administrative costs (as opposed to benefits). For 
              childless adults, the rate is generally 50%.

          Background: Under federal law and regulation, health care 
          providers that accept federal funding are required to provide 








          AB 2392 (J. Perez)
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          linguistically accessible services to all patients. Under state 
          law and contract requirements with the Department of Health Care 
          Services, health plans providing Medi-Cal managed care service 
          are required to provide translation services to patients.

          Despite these requirements in law, there are indications that 
          not all Medi-Cal beneficiaries are receiving care in a 
          linguistically appropriate manner. According to the California 
          Health Interview Survey, about 8% of adults in Medi-Cal had 
          difficulty understanding their doctor or required another person 
          to help them understand their doctor. Similarly, about 7% of the 
          parents of children enrolled in Medi-Cal had difficulty 
          understanding their doctor or needed another person to help them 
          understand their doctor.

          Proposed Law: AB 2392 would require the Department of Health 
          Care Services to establish a program to provide interpretation 
          services to Medi-Cal beneficiaries who have limited English 
          proficiency.

          Specifically, the bill:
              Would require the Department of Health Care Services to 
              seek federal funding to establish a program to provide for 
              certified medical interpretation services to Medi-Cal 
              beneficiaries.
              Would require the services to be provided in both Medi-Cal 
              fee-for-service managed care.
              Would authorize providers or managed care plans contracting 
              with Medi-Cal to use the program.
              Would require the Department to develop a mechanism to 
              leverage existing sources of funding to offset additional 
              General Fund costs.

          Staff Comments: The availability of enhanced federal financial 
          participation for translation services indicates that there may 
          be opportunities to improve access to care for non-English 
          proficient Medi-Cal beneficiaries at a reduced cost to the 
          state. On the other hand, it is not clear whether the program to 
          provide certified translation services, are required under the 
          bill, would be a more economical method of providing translation 
          services than the current methods used by health care providers. 
          If a centralized system managed by the Department is more costly 
          than the methods currently in use, cost savings may be minimal.









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          Improving translation services for people with limited English 
          proficiency would likely have mixed impacts on Medi-Cal costs. 
          By improving enrollees' ability to communicate with providers, 
          the bill is likely to enable enrollees to more easily access 
          care, increasing utilization and costs. On the other hand, 
          better communication between a patient and a provider may 
          improve the patient and the provider's ability to manage the 
          patient's health, potentially reducing long-term costs.