This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Imagine a grandmother going to the emergency room and relying on her 5-year-old grandchild to describe her symptoms and relate doctors' questions and instructions. Consider how a busy young mother might put aside a pages-long renewal notice from Medicaid or WIC in a language she cannot read. Think about a 45-year-old man recovering from surgery and trying to manage his own aftercare when he can understand neither the verbal nor written instructions his medical team provides. These are just a few of the many challenging health care scenarios that play out for Michiganders who do not fluently speak or read English.

"They’re experiencing language barriers across the whole spectrum of health care services, wherever information needs to be communicated," says Simon Marshall-Shah, senior policy analyst at the Michigan League for Public Policy. "Language barriers like these can really be a serious impediment to health literacy and ultimately better health outcomes."

However, new state legislation will help to address these language challenges and ensure better health outcomes for Michiganders who aren't fluent in English. Two bills comprising Michigan's Statewide Meaningful Language Access Coordination Act, which took effect in February, will require public services to be more accessible to non-English speakers. The new law is particularly important in the health care world, although it's not limited to health agencies. The act requires state departments and agencies to take reasonable steps to help Michigan residents with limited English proficiency access state services. Nearly 950,000 Michiganders 5 years old and over speak another language besides English at home.

Because the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, religion, sex, or national origin, health care systems, private insurers, and other entities receiving federal funds have long been required to ensure language access. However, those requirements did not extend to state or municipal health care agencies relying on state or local funding. As a result, many Michiganders have experienced language barriers when trying to access health care.

"Language barriers impair the ability to read information, for example, when filling out forms, following a care plan, or applying for benefits or services. They also impair understanding during oral communication as [patients] try to explain symptoms, understand a diagnosis, or know what their treatment options are," Marshall-Shah says. "Better language access improves health outcomes [and] will lead to better quality care, more culturally competent care, and better health outcomes."
Simon Marshall-Shah.
The new law requires state agencies and departments to take meaningful steps to provide language access via oral language interpretation, document translation, and translation of outreach materials, forms, and documents. Language access must be made available in the needed language, for example Spanish or Arabic, when 3% or more than 500 people of the population in the region served by the agency or department have limited English proficiency (LEP). Marshall-Shah says the law is "really well designed."

"There's a threshold that's quite low for determining whether vital documents in particular are translated — and what that means is that there's more access to in-language information for a greater group of people," he says.

In addition, the act is explicit about providing reasonable language access and not relying on bystanders, like employers, children, or family members, to translate. The bills also encourage state agencies to develop staff training, public awareness initiatives, and language access plans to ensure success. Marshall-Shah says the act's individual complaints process is also meaningful.

"It really is an accountability mechanism for agencies to ensure that they're providing meaningful language access," he says.

MIRC helped make it happen

For the Michigan Immigrant Rights Center (MIRC), passage of the act was a cause for great celebration. MIRC began working with Michigan Sen. Stephanie Chang eight years ago on drafting a bill to address language access.

"When we talk about language access, we're talking about the ability for individuals with limited English proficiency, who speak English less than very well, to meaningfully access the same programs and services as fluent English speakers with the aid of oral interpretation or written translations," says Christine Sauvé, who works in policy, engagement, and communications for MIRC.
Christine Sauvé.
Sauvé says language barriers affect all aspects of the health care experience. She cites a National Immigrant Law Center report that found that people with limited English were three times more likely to test positive for COVID-19, and those hospitalized with the virus were 35% more likely to have serious health outcomes. Overall, patients with LEP make twice as many medication dosing errors, have worse outcomes for certain cancers and mastitis, and are less likely to control diabetes. Children of parents with language barriers are twice as likely to experience adverse medical events when hospitalized. The report states, "Conversely, when language services are provided, health outcomes improve."

Over the years, MIRC has taken on many cases for individuals who faced language barriers at state agencies. Some reported choosing their preferred language in a phone prompt and then being connected to a person who spoke only English. Others made requests for translators or interpreters offered by the agency, but their requests were disregarded. Others reported checking a box to receive documents in their preferred language and then later receiving documents printed in English.

"Sometimes, even if there was a Spanish-speaking worker in the department in the physical office, accessing the service was still intimidating because clients had to navigate English-speaking security or there was a lack of translated signage in the building," Sauvé says.

Language access needed at city, county level

As state agencies begin complying with the new law, Sauvé hopes to see more counties and municipalities introduce or improve translation and interpretation services for people with language barriers. In Flint, the Center for Civil Justice has been focusing on helping people with language barriers access and maintain Medicaid coverage. With the COVID-19 public health emergency unwinding, people are supposed to receive Medicaid re-enrollment notices in their preferred language, but that doesn't necessarily mean they do.
Kelly Bidelman.
"We've learned through contacts with our community partners that serve the LEP community [that] a lot of important documents such as denials or termination of benefits are not being translated," says Kelly L. Bidelman, executive director for the Center for Civil Justice. "We had a Spanish speaker that had Women, Infants, and Children (WIC) benefits, which allowed her to get certain foods and other benefits. She never used it because she didn't know what the documents said."  

Bidelman believes the new state requirements will help.

"The bills require the Office of Global Michigan to be responsible for the statewide language access coordination," she says. "It also requires [state] departments to provide a list of vital documents that are already translated, the language of the translation, and a staff training plan, which I think is huge because we've encountered MDHHS staff that don't know how to go about getting a document translated when it's been requested."

Improved language access will not only improve health, but also help attract and retain workers in Michigan. Michigan’s top occupations employing foreign-born workers include software developers, agricultural workers, physicians, physical therapists, and postsecondary teachers.

The act also will help protect migrant workers’ rights and address illegal child labor in the state. As LEP parents are able to understand labor laws and access more services, their children will be less likely to risk their health on farms and in factories.

"It was very exciting to finally get [the act] across the finish line," Sauvé says. "Moving forward, we are planning a community training to help folks learn about this new act and learn how to navigate the new complaint process once it's formalized."
 
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Christine Sauvé photos by Steve Koss. All other photos courtesy of the subjects.