Kansas hasn’t paid for medically necessary interpreting services. You can help change the system.

The Kansas Reflector welcomes opinion pieces from writers who share our goal of widening the conversation about how public policies affect the day-to-day lives of people throughout our state. Rachel Showstack is an associate professor of Spanish at Wichita State University and the founder and president of the organization Alce su voz (‘Speak Out’), whose mission is to improve health equity for speakers of Spanish and Latin American indigenous languages in Kansas. You can read the following column in Spanish here. (Leer en español.)

For the past three years, I have been in conversations with Spanish-speaking families, bilingual health practitioners, interpreters and health care administrators to try to understand why Kansas health care institutions cannot consistently provide qualified interpreting services for individuals who need them.

I have heard stories of bilingual Kansans who grew up serving as their parents’ interpreters and sometimes had to interpret difficult health news, such as a cancer diagnosis, and parents who avoided describing their pain to doctors because they did not want their children to know they were suffering. I also talked with a Spanish-speaking woman who did not understand the treatment she was to receive until after she emerged from a hysterectomy, and a mother whose son’s appendix burst because he was misdiagnosed and sent home from the emergency department to suffer untreated appendicitis.

It is not new news that use of unqualified interpreting services can lead to severe health outcomes. The Spanish word “intoxicado” is known as the “$71 million word,” because of a case in Florida in which it was incorrectly interpreted as “intoxicated” rather than the intended meaning of “poisoned,” leading to inadequate treatment of the patient and ultimately resulting in the patient becoming quadriplegic.

The patient received a malpractice settlement of $71 million dollars.

Qualified interpreting services save lives. Unfortunately, Kansas has not figured out a way to fund these much-needed services.

In my conversations with CEOs and other administrators at several Wichita health care institutions, every health care administrator has told me that it is difficult for their institution to consistently provide qualified interpreting services because of cost. When patients attend medical visits, they often do not know to schedule an interpreter in advance or are not able to do so because it is impossible to plan for emergencies.

However, the only way for Kansas health care institutions to receive reimbursements for interpreting services for Medicaid patients is through managed care organizations (MCOs), which only provide reimbursement for scheduled services. As a result, Kansas health care institutions end up paying out of pocket for most of the interpreting services they offer.

Federal regulations require health care entities that receive federal funds to provide qualified interpreting services for patients who need them, including Section 1557 of the Affordable Care Act (the nondiscrimination provision), and the Culturally and Linguistically Appropriate Service standards.

However, in Kansas, health care institutions claim these regulations constitute an unfunded mandate because of the difficulties that they encounter with attaining Medicaid reimbursements.

Difficulties with reimbursement for care do not only affect interpreting services; they also impact psychotherapy services and other types of care. This year, when experiencing mental health challenges, I had a very difficult time finding an available psychotherapist for myself. I was on a waiting list for over six months before I could finally begin treatment. A licensed marriage and family therapist who practices in Wichita told me that the scarcity of mental health services in Kansas is partially caused by difficulties from the MCO system.

To be sure, interpreting services for patients who are not enrolled in Medicaid cannot be reimbursed with federal funds. Changing the MCO system is not the only necessary solution because health care providers who receive federal funds are required to ensure language access for all of their patients. However, according to the National Health Law Program, costs required to expand an existing reimbursement system to fund services for other patients who need language assistance would probably be minimal. Of course, expanding Medicaid in Kansas could help decrease this cost.

It appears that the financial system for health care in Kansas has resulted in both difficulty in attaining care and a lower quality of care, making it impossible for Kansas to support health equity for disadvantaged groups.

Before this system can be improved, it will be impossible for hospitals and safety-net clinics to offer equitable care for patients who need language assistance.

Improvements to the system will have to wait, because Republicans in the state Legislature voted back in April to delay negotiations of Kansas Medicaid contracts until 2023. Their intention was to leave decisions about the contracts to the person who will be elected as Kansas governor in November.

While this system is being negotiated, Kansas health care institutions must develop up-to-date language access plans, documents that describe how the institution will respond to the language access needs of consumers in the area and provide language support services to individuals who need them. 

Language access plans include notices of how the institution will let its patients, clients, consumers, and beneficiaries know about the availability of services. Perhaps if patients were informed that they can schedule an interpreter in advance, they would be more likely to do so. 

Finally, the Kansas Department of Health and the Environment needs to determine how to use state funds for interpreting services for patients not enrolled in Kancare.

Although decisions will not happen for a while, discussions about KanCare are happening now. Kansans have the opportunity to speak up about concerns with the current KanCare system in a series of in-person public hearings that will take place this week in Topeka, Kansas City, Hays, Pittsburgh, and Wichita.

You can find more information about the hearings here.

Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.