Central New York Health Insurer Failed To Provide Legally Required Information and Notices to Enrollees Who Understood Limited English, Including Disabled Consumers
Insurer Agrees To Improve Policies and Services to Eliminate Language and Communication Barriers for Enrollees, Pay $25,000 Penalty
Schneiderman: All New Yorkers Are Entitled To Equal Access to Health Care
SYRACUSE – Attorney General Eric T. Schneiderman today announced a settlement agreement with Molina Health Care of New York (“Molina”), formerly Total Care of New York (“Total Care”), following claims that the Central New York health insurer failed to provide important information and notices to Limited English Proficiency (“LEP”) enrollees—including disabled consumers enrolled in their home care program. Under the terms of the agreement, the company will take steps to remove language and communication barriers for New Yorkers who enroll in their health plans and pay a $25,000 civil penalty to the State of New York.
“New York health insurers have a fundamental responsibility to ensure that vulnerable consumers, especially those dependent on home care services, receive critical information about their health care in a way they can understand,” said Attorney General Schneiderman. “All New Yorkers are entitled to equal access to health care – and we urge anyone who suspects that they are not being treated fairly to contact us right away.”
Click here to read the settlement agreement.
Attorney General Schneiderman initiated an investigation of Total Care after receiving complaints that LEP enrollees, whose primary language was neither English nor Spanish, failed to receive important informational materials and notices in their primary languages, such as Nepalese and Somali. The complaints also alleged that Total Care failed to adequately notify and provide communication assistance services to at least one enrollee who is deaf, and that Total Care used notices that did not adequately describe member benefits. These complaints stemmed from Total Care’s provision of personal care services through the Consumer Directed Personal Assistance Program (“CDPAP”) for its Medicaid Managed Care health plans.
CDPAP is intended to permit chronically ill and or physically disabled individuals in need of home care services with flexibility and freedom of choice in obtaining personal care services, including affording them an opportunity to hire certain qualifying relatives or friends as caregivers.
Following the Attorney General’s investigation, Total Care agreed, among other things, to revise policies to include interpretation and translation services so as to meet both state and federal requirements; to require Member Service representatives to document enrollee’s preferred mode and or language of communication; and to provide a link on its website homepage advising consumers of the availability of free language assistance services and auxiliary aids for those with visual or hearing impairments, the method for accessing those services via telephone or email, and the method for filing a complaint about those services. Additionally, Total Care revised its communications to members to describe more accurately who may serve as a personal care assistant for Medicaid enrollees and mailed over 150 corrective letters to members who received a former inaccurate letter.
Molina’s service area in Central New York covers Cortland, Onondaga, and Tompkins counties. According to 2014 Census data, 11 percent of this region’s population (over age five) speaks a language other than English, and of this group 34.5 perfect speak English less than “very well.” Total Care was acquired by Molina in 2016 and serves more than 35,000 members through its Medicaid Managed Care and Child Health Plus health plans.
Both federal and state laws require health plans like Molina to provide enrollment notices and informational materials in an easily understandable manner, to translate materials taking into consideration the language needs of enrollees, and to provide free oral interpretation services.
Consumers with questions about this settlement may contact the Attorney General’s Health Care Bureau Helpline at 1-800-428-9071 or the Civil Rights Bureau at (212) 416-8250.
The investigation of this matter was conducted by Assistant Attorney General Brant Campbell of the Attorney General’s Health Care Bureau and Assistant Attorney General Anjana Samant of the Civil Rights Bureau. The Health Care Bureau is led by Bureau Chief Lisa Landau and the Civil Rights Bureau is led by Lourdes Rosado. Both the Health Care and Civil Rights Bureaus are part of the Social Justice Division, led by Chief Deputy Attorney General Alvin Bragg.
