Thousands of non-English speaking Floridians who go online to sign up for Medicaid and other welfare programs are met with a frustrating barrier — the state's main webpage is only in English, even though the applications a few clicks away are translated in Spanish and Creole. Health advocates worry how thousands of non-English speakers will fare in signing up for Medicaid expansion or sorting through complicated health plans under the federal health law that is confusing even for lawmakers.
With its vast immigrant population from Cuba, Latin America and Haiti, nearly 4.5 million or 26 percent of Floridians speak a language other than English. More than 16 percent said they did not speak English well and nearly 10 percent don't speak English at all, according to 2007 U.S. census data.
"(Applying under the Affordable Care Act) is going to be like the Florida system on steroids and so complicated with all online stuff and is there going to be the ability or people with English language proficiencies issues to navigate the online process and get assistance when they need it," said Miriam Harmatz, a health law attorney with Florida Legal Services. "Because of our experience in Florida, we're extremely concerned."
Citizens and health advocates have long complained that Florida's current system is largely designed for people to sign up for welfare benefits, including Medicaid, online. Trying to get help from a real person is also challenging, with roughly 67 percent of callers to the Department of Children and Families' call center getting a busy signal. Only about 31 percent of callers got through to an operator during a six-month period from December 2011 through May 2012, according to statistics provided by DCF to Florida Legal Services, Inc.
"It's not even getting the benefit, it's applying for the benefit that's harder," said Jacqueline Michel-Chow, a paralegal with Legal Services of Greater Miami, who helps roughly 100 Spanish and Haitian speakers a year with their welfare applications.
The Department of Children and Families, which handles Medicaid applications, plans to expand its call center operations, including adding more bilingual agents to accommodate the additional hundreds of thousands of applications under the federal health law if the state decides to expand the program.
Roughly 1 million residents will be eligible under Medicaid expansion and hundreds of thousands more will be eligible for federal money to help purchase their own insurance through online health exchanges. The new marketplaces, which are open for enrollment this October, are supposed to take the confusion and anxiety out of buying private health insurance for individuals and families who buy their coverage directly. Exchanges are meant to have the feel of an online travel site.
But figuring out if you're eligible for financial aid and if so, how much you will receive and then sorting through various plans to determine which benefits best meet your needs can be a Herculean task for non-English speakers, advocates said.
The federal law requires staffers or so called "navigators" to help people with limited English proficiency walk through those tasks. But it's unclear how many navigators will be deployed or where and whether it will be enough to meet demand in areas like South Florida with high Spanish and Creole speaking populations. Beyond that, the burden to help non-English speakers is on insurers and advocates said the requirements are limited.
Insurers are required to translate various documents pertaining to the law, including a summary of benefits. But insurers only have to make special efforts to do so in counties in which 10 percent or more of the population is literate only in a language other than English, said Greg Mellowe, policy director for the health advocacy group Florida CHAIN.
"That to us seems a very high bar. No Florida county reaches this threshold for any language other than Spanish," Mellowe said.
The Spanish requirement applies in only 8 of 67 counties, including Miami-Dade, Osceola, and Collier. That also leaves roughly 100,000 Haitian Creole speakers without translations just in South Florida, according to statistics from the National Center on Immigrant Integration Policy. Florida has one of highest percentages of Haitian Creole speakers in the country.
Federal health officials are still developing outreach and education plans for non-English speakers, building on best practices from when they launched the Medicare Prescription Drug Benefit and children's health insurance programs.
"We are committed to making information available in linguistically and culturally appropriate ways, including reaching a large Spanish speaking population," according to a statement from the Centers for Medicare and Medicaid Services.
Several states around the country are using millions of dollars in federal grants for community-based organizations, faith-based groups, nonprofits and local governments to compete for outreach and education grants. It's too soon to say what organization will receive those grants in Florida.
Those efforts will be especially important in South Florida with roughly nearly 1.5 million Spanish speakers in Miami-Dade County alone and more than 741,000 of those residents said they do not speak English very well. Broward County has more than 371,000 Spanish speakers with more than 148,000 who do not speak English very well. Nearly 200,000 Spanish speakers reside in Palm Beach County with nearly 100,000 indicating they do not speak English very well. In central Florida, more than 242,000 Spanish speakers live in Orange County and 94,000 do not speak English very well, according to census data.