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J Health Care Poor Underserved. 2009 May;20(2):423-31. doi: 10.1353/hpu.0.0127.

Are state Medicaid application enrollment forms readable?

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  • 1Univ. of Tennessee Graduate School of Medicine, Dept. of Family Medicine, 1924 Alcoa Hwy., U-67, Knoxville, TN 37920, USA.


We sought to assess readability and layout characteristics of state-issued Medicaid enrollment applications. We attempted to locate Internet-based Medicaid enrollment applications from each of the 50 states and the District of Columbia. Readability of each Medicaid enrollment application "Signature" page was calculated using McLaughlin's Simplified Measure of Gobbledygoop formula, while layout characteristics were assessed utilizing criteria included in the User-Friendliness Tool. Readability of Medicaid enrollment application Signature pages ranged from 11th to 18th grade level (M+/-SD=15.5+/-1.5). Most (66%) applications did not use a recommended font size (> or =12 point). None of the applications required little work to make them comply with good formatting standards according to the User-Friendliness Tool. Medicaid enrollment applications overall exhibit text font sizes below 12 point, crowded formatting, and excessively high reading demands. State health departments should revise their Medicaid enrollment applications to adhere to established low-literacy guidelines to improve understanding and comprehension by potential enrollees.

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