Here’s how state-based health plans can reduce Medicaid coverage gaps for eligible individuals with limited English proficiency. 


There have been a handful of significant developments to improve the accessibility of low- or no-cost health insurance over the last 15 years or so. However, many qualifying individuals with limited English proficiency (LEP) aren’t aware that they can receive these benefits.

Studies have shown that individuals with LEP have not taken advantage of improvements to Medicaid accessibility as much as their English-speaking counterparts have.

This is where culturally competent outreach can make a difference.

Culturally competent outreach refers to any sort of outreach strategy that accounts for the cultural context of its target demographic. For individuals with LEP, this doesn’t just mean speaking to them in their language, but also understanding and remaining sensitive to their cultural background. By emphasizing cultural competence, state-based health plans can connect with LEP individuals and inform them about whether they qualify for Medicaid.

It’s an essential part of ensuring that LEP individuals have proper access to the health services they need to thrive. Although individuals with LEP make up a comparatively large proportion of Medicaid recipients, there are still thousands of individuals with LEP who are paying more than they need to for their healthcare — or worse, going uninsured.

As state-based health providers continue to work toward reducing coverage gaps for eligible individuals with LEP, it’s clear that culturally and linguistically appropriate outreach is key to making healthcare more accessible. Here’s what state-based health plans can do to develop a culturally competent outreach strategy for individuals with limited English proficiency to help close coverage gaps.

Speak Their Language

Of course, one of the most important aspects of any outreach strategy is making sure that you’re communicating with people in the language they speak. This is doubly important when targeting individuals who have LEP.

Developing a culturally competent outreach strategy for these populations should start with research on which non-English languages are spoken widely among individuals with LEP in the state. This information will help guide efforts to connect with and engage communities where English isn’t the primary language.

Most US residents with LEP speak Spanish as their primary language, according to research from the Brookings Institute. The most prominent languages among communities with LEP can vary significantly from zip code to zip code, so it’s important to do thorough research and identify all of the languages that are prominent in a given area.

The Department of Health and Human Services recommends that providers translate vital written documents into any language spoken by 1,000 (or 5%, depending on the size of a given population) or more individuals with LEP in a certain population. This is also a good outreach strategy for state-based health plans.

Upon identifying these target languages, more research into local language access plans and mandates is also an important step. While federal mandates like the Civil Rights Act and Section 1557 of the Affordable Care Act include language access provisions for state Medicaid agencies, it’s important to know what’s also required in each state. Some states — like New York, for example — have their own language access policies that state agencies must adhere to.

Translate written materials

After conducting a thorough review of the language access plans and policies is to commission translations of written documents and texts into the target language (or languages). Documents that will need translation include — but are not limited to — the following:

  • Forms
  • Flyers
  • Notices
  • Webpages
  • Advertising materials
  • Informational texts (such as brochures)

These written documents will likely be an individual’s first impression of the health plan, making it crucial that individuals with LEP can understand them easily. And, in the case that they qualify, it’s also important that they understand how to actually enroll in the plan and exactly what that plan covers.

Offer interpreting services

While written documents are an integral component of any outreach strategy, some folks may prefer to talk to a human being, rather than scroll through a website or flip through an informational pamphlet. Or there might be information they just can’t find in writing as easily as they could by chatting with somebody.

As such, it’s important to staff phone hotlines and offices with highly qualified bilingual workers who can communicate with individuals who prefer to speak in a language other than English. Offering separate phone lines for different languages is one way to improve accessibility for those who don’t speak English.

Interpreters are also key here — they serve as a sort of medium between the insurance provider and the patient, seamlessly switching between each party’s preferred language. Over-the-phone, video remote, and in-person interpreting services are an important part of connecting with individuals who have LEP. State agencies must also be sure to closely research interpreting agencies to make sure they offer services in the most in-demand languages.

Reflect Their Culture

While the right language is a crucial part of reaching out to and offering culturally competent care to individuals with LEP, it’s also important to make sure your efforts are sensitive to their cultural background. Translation and interpreting ensure that prospective Medicaid insureds can understand the information, but they must also be presented in a way that resonates with an individual’s cultural values.

Moreover, as intertwined as culture and language are, they’re still two distinct entities. For instance, a monolingual French speaker from Quebec may be more responsive to different strategies than one from Senegal, and vice versa. Taking into account the communication strategies and acceptable topics that vary from culture to culture is an important part of achieving true cultural competence.

Consult with experts on the target culture. Partnering with community organizations and utilizing local resources can be an effective way to reach LEP individuals and provide them with information about Medicaid eligibility and enrollment. These organizations may have connections and relationships with LEP communities that can be leveraged to facilitate outreach and communication.


Engaging outreach campaigns have been shown to boost Medicaid enrollment and improve health outcomes for those most in need. By developing outreach strategies that emphasize cultural competence, state-based health plans can help close Medicaid coverage gaps among individuals with LEP.

Avantpage strongly emphasizes accessibility in our website localization, content translation, and interpreting services. If you need help getting started, contact us at [email protected] or (530) 750-2040.