California Healthline

California residents with limited English proficiency are underrepresented in the state’s health insurance exchange, according to a recent report by the Greenlining Institute in Berkeley, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 6/26).

Details of Report

For the report, researchers examined:

  • Data from Covered California (Aliferis, “State of Health,” KQED, 6/26);
  • Interviews with enrollment counselors in Los Angeles and Fresno counties; and
  • Interviews with groups that received outreach and education grants from the exchange.

Interviews with enrollment counselors were focused on Los Angeles and Fresno counties because both areas had high numbers of uninsured individuals before and after the first open enrollment period and the counties also “mirror the racial/ethnic, linguistic and Internet access demographics” of California, according to the report.


Overall, researchers said that cultural and linguistic differences remain one of the exchange’s “most pressing problems.” They noted that all of the organizations included in the study reported “cultural and linguistic differences as the biggest barrier to educating and enrolling more people in health care coverage” (Medina/Saporta, Greenlining Institute report, June 2014).

The report found that 20% of exchange enrollees do not primarily speak English, compared with 44% of the Californians overall who do not speak English as their first language, according to Covered California data.

The report also found that online information was available only in English and Spanish, while materials in other languages only were available in printed form (“State of Health,” KQED, 6/26). Some enrollment counselors reported running out of the printed materials in at least some of the other languages and said that information in Spanish-language materials was poorly translated and hard to understand.

In addition, enrollment counselors said that the $58 payment offered for each person they enrolled was “unrealistic given the amount of time needed to complete the applications,” according to the report.

Report Recommendations

The report recommended that Covered California take several actions to boost exchange sign-ups among non-English speaking residents, including:

  • Ensuring outreach and enrollment activities are better coordinated and funded;
  • Expanding social media outreach and other programs that were successful during the first open enrollment period;
  • Hiring a director of diversity and cultural competency to improve and tailor the next round of enrollment outreach to underrepresented demographics;
  • Collecting demographic data earlier in the enrollment process; and
  • Offering information on the online portal in the 13 most commonly spoken languages in the state (Greenlining Institute report, June 2014).

Covered California’s Response

Covered California spokesperson Anne Gonzales said that the exchange is considering whether to offer sign-up information online in 13 different languages but that “no firm date on when that functionality will be added, or which languages will be added” has been set.

Gonzales noted that the exchange is reviewing its Asian-language resources and has “recalibrated and focused resources” on making improvements to Spanish-language resources.

Gonzales also said that Covered California is “moving away” from offering separate grants to individuals helping with outreach and enrollment. The exchange is implementing a “navigator” business model that will offer $16.9 million in grant funding to organizations helping with either function (“State of Health,” KQED, 6/26).