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J Immigr Minor Health. 2011 Apr;13(2):293-8. doi: 10.1007/s10903-010-9435-4.

How readable are Spanish-language Medicaid applications?

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  • 1University of Tennessee Graduate School of Medicine, Knoxville, TN, 37920, USA.


Nationally, Hispanics comprise nearly one-quarter of all non-elderly Medicaid recipients. We evaluated readability, layout characteristics, and document complexity of state-issued Spanish-language Medicaid enrollment applications. We located and analyzed Internet-based Spanish enrollment applications from 37 states and the District of Columbia. We calculated the readability of each Medicaid enrollment application "Signature" page using the Spanish Lexile Analyzer. We assessed application layout characteristics utilizing the User-Friendliness Tool, and we evaluated document complexity using the PMOSE/IKIRSCH scale. The average Lexile score estimated an 11th-12th grade reading level (M = 1184, SD = 192) for "Signature" pages of enrollment applications. Most applications used small font size and lacked adequate white space. Document complexity ranged from level 3 (moderate) to level 5 (very high); the majority of applications ranked at level 4 (high). Spanish-language Medicaid enrollment applications should be revised to adhere to low-literacy guidelines, which may improve the accessibility of Medicaid coverage for eligible Spanish-speaking families.

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