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California To Study Its Medical Interpretation Services

A receptionist helps patients at San Diego's La Maestra Community Health Center in City Heights in this undated photo.
Katie Schoolov
A receptionist helps patients at San Diego's La Maestra Community Health Center in City Heights in this undated photo.

More than six months after it was approved, a state assembly bill funding a study on language interpretation services available to Medi-Cal patients is slowly moving toward implementation.

California To Study Its Medical Interpretation Services
New law will study and pilot a program on interpretation services for patients who speak a language other than English.

The bill, authored by then-Assemblywoman Toni Atkins, D-San Diego, authorized $3 million for state health officials to examine California’s current procedures and launch a pilot program in up to four locations.

California Department of Health Care Services Spokesman Tony Cava said employees are still developing a plan to carry out the legislation.


“We’re working with our stakeholders as we lay the groundwork for this effort," Cava said in a phone interview. "Some of the steps include hiring internal support staff, creating budgets and work plans and beginning to work to hire an external vendor.”

He expected to have another update in May.

For years, residents in City Heights have pushed for better services, including in-person translators instead of an over-the-phone-system used by many health care providers. Census estimates show more than two-thirds of that community speak a language other than English at home.

Some San Diego health care workers expressed interest in playing host to one of the pilot programs authorized by Atkins’ bill. More than one-third of the region's population over the age of 5 speaks a language other than English at home, estimates show. Nearly half of that total — or about 466,000 people — speak English less than “very well,” according to 2011-2015 American Community Survey 5-Year Estimates. San Diego County is home to more than 3.1 million people.

In a news release following the signing of the bill in September, Atkins said 7 million Californians speak English "less than very well."


However, previous attempts to provide such a service under Medi-Cal were defeated. In 2013, Gov. Jerry Brown vetoed a bill that would have created a system to pay interpreters through the state's Medicaid health care program. At the time, states were dealing with the roll out of the Affordable Care Act and the legislation would have added another "complex element," Brown said. The Democratic governor rejected a similiar bill in 2014 because he was concerned about additional spending.

Brown signed Atkins' AB 635 last fall after it passed the Assembly and Senate with only a handful of no votes in each house, including from Assemblyman Rocky Chávez. The Republican, who represents North San Diego County, was not immediately available to comment.

Cynthia Roat, a Washington-based consultant on language access in health care, said research indicates improving medical interpretation procedures could be a beneficial move to patients and taxpayers. Facilities that receive federal money must provide language services to clients with limited English proficiency, she said.

“It shortens length of stay in hospitals, it lowers the number of errors that are made, it improves relationships, patient-provider relationships, and what might be of interest to the legislature is that it actually brings down the cost of care, even if you count in the cost of paying for an interpreter,” said Roat, who was also the keynote speaker at California Healthcare Interpreters Association’s annual conference last year.

Roat pointed to a 2002 study that compared the medical outcomes of patients with limited English proficiency who received an interpreter, patients with limited English proficiency who didn’t receive an interpreter (non-interpreted patients) and English-speaking patients who didn’t require an interpreter.

According to the study, “In post-discharge follow-up, interpreted patients received significantly more primary care and specialty clinic referrals than did either [non-interpreted patients] or [English-speaking patients]; were more likely to follow-up in clinic than [non-interpreted patients]; were less likely than [non-interpreted patients] to return to the emergency department; and had the lowest charges from both clinic visits and emergency department returns of all three groups.”

Additionally, Roat said, it's important to train professionals specifically as medical interpreters instead of just legal interpreters. The latter is an adversarial situation, she said, while the former is a collaborative situation, meaning interpreters can work with the patient to help them better understand what a health care provider is saying.