Medicaid Reimbursement for Language Access Services

August 19, 2010

Increased CHIPRA Translation/Interpretation Match Helps Eliminate Language Barriers

On July 1, 2010, the Center for Medicare and Medicaid Services (CMS) issued a guidance letter explaining the increased matching funds for translation and interpretation services under Medicaid and the Children's Health Insurance Program (CHIP), as provided in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). 1  The first part of the letter describes the increased administrative match for translation and interpretation services under Medicaid and CHIP. This is followed by a five-page Question and Answer section on the increased administrative match. 2

Matching Funds for Translation and Interpretation before CHIPRA

Before CHIPRA, States could claim federal matching funds for translation and interpretation costs as an administrative expense or as a medical assistance-related expense. 3  If provided by a Medicaid agency employee or a contractor of a Medicaid agency, these costs can be claimed at a standard administrative rate of 50 percent or if translation or interpretation services were built into the rate paid for the covered benefit then the expenditure is matched under the State’s applicable Federal medical assistance percentage (regular FMAP) rate. Under CHIP, these expenditures may be claimed as administrative expenditures at the enhanced CHIP Federal medical assistance percentage (enhanced FMAP) but they are subject to the statutory 10 percent cap on administrative expenditures.  The expenditures may also be claimed in CHIP as child health assistance either through provider rates or under the enabling services benefit, at the enhanced FMAP under CHIP (and then not subject to the 10 percent cap). While States can still continue to claim these costs as administrative or benefits-related in either Medicaid or CHIP, CHIPRA provides for federal matching at an increased rate.

Increased Translation and Interpretation Match under CHIPRA

Section 201(b) of CHIPRA provides an increased match for administrative expenditures for translation or interpretation services in connection with the “enrollment of, retention of, and use of services” under CHIP and Medicaid. This increased match is available for individuals whose spoken or written language is not English and whose primary spoken or written language is American Sign Language (ASL) or Braille. “For Medicaid, the increased match is 75 percent of allowable expenditures. For CHIP, the increased match is 75 percent, or the State’s enhanced FMAP plus 5 percent, whichever is higher. However, the increased translation/interpretation match is only available for eligible expenditures claimed as administration of the Medicaid or CHIP plan, not expenditures claimed for benefits. Therefore, under CHIP, the expenditures that qualify for the increased match are subject to the 10 percent cap on administrative expenditures. Historically, the vast majority of States have not reached their CHIP administrative cap." 4

Activities Covered by the Increased Translation and Interpretation Match

To receive the increased translation/interpretation match, States and providers may contract with or employ staff who provide solely translation or interpretation functions and who claim related costs as administration or pay for translator or interpretation activities to assist medical providers for the service as an administrative expenditure in addition to the rate for the medical service itself. If “translation or interpretation services are provided by a contracted managed care entity (MCE) and funded through a capitated payment from the State, related costs in that rate are not eligible for the increased translation/interpretation match rate because the capitated payment is a benefit expenditure, not an administrative expenditure.” 5

Some activities for which the translation/interpretation match would be available include translating forms, web sites and enrollment and outreach materials into languages other than English or making translation/interpretation services available in order for beneficiaries to enroll in the program, maintain eligibility, and access covered services. While the list of activities is not exhaustive, they must be deemed by the Secretary of the Department of Health and Human Services (HHS) to be “proper and efficient” for the administration of the State plan. To assist States in obtaining these translation/interpretation matching funds, new line items have been added to CMS expenditure reporting forms.

The last section of the CMS guidance letter provides detailed responses to several questions States may have including: which activities are covered by the increase in translation/interpretation match, how States will be reimbursed for these costs, and which individuals are eligible to receive translation/interpretation services.

Footnotes

1.  See Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Pub. L. No. 111-3, https://www.cms.gov/HealthInsReformforConsume/Downloads/CHIPRA.pdf
2.  CMS, Increased Federal Matching Funds for Translation and Interpretation Services under Medicaid and CHIP, July 1, 2010, http://bit.ly/July1_CMS (PDF).
3.  See CMS, August 31, 2000, State Medicaid Director Letter, http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/lettertostatemedicaidproviders.pdf (PDF)
4.  Id. at 2.
5.  Id. at 3