Low Literacy a Barrier to Medicaid Coverage

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Many studies have shown that there are significant literacy related barriers to applying for and remaining on Medicaid health insurance. Simplifying the forms may help families stay enrolled, resulting in better medical care, according to research presented over the weekend at the Pediatric Academic Societies (PAS) annual meeting.

With the expansion of insurance coverage under the health reform law, the number of people applying for Medicaid is likely to increase.

The study, led by Susmita Pati MD MPH, pediatric researcher at The Children’s Hospital of Philadelphia, compared the reading level of Medicaid renewal applications in all 50 states. The results showed that 92% were written at or above the fifth-grade reading level. 40 million American adults are not able at this level.

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Healthy People 2010 defines health literacy as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." The National Adult Literacy Survey reports that adults with low health and functional literacy have less ability to care for chronic conditions and cost the healthcare system between $32 and $58 billion. Medicaid finances 47% of the additional health care expenditures.

Because caregivers have difficulty completing the forms, the risk of a child getting dropped from coverage increased significantly with each grade level increase in the language used for the Medicaid renewal application. The resulting delay results in inadequate medical care, missed preventive visits, and unfilled prescriptions.

Although the majority of states have guidelines for readability set for writing application forms, 46% fail to meet them. Unfortunately, with funding being limited, state Medicaid programs have staff shortages and are unable to dedicate time to revamping the forms to be more user-friendly.

The authors stress the importance of dedicated resources to simplify applications to improve retention of children in the Medicaid program.

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