Senator Eliot Shapleigh - El Paso, Texas

Is the state doing enough to ensure that Spanish-speaking families do not face obstacles in enrolling their children in the Children's Health Insurance Program? That's one question raised in a new report on programs that provide free or low-cost health insurance for Texas children.

The report found that Spanish-speaking families were less likely to renew coverage for CHIP. Researchers at the Institute for Child Health Policy in Florida recommended that the state review materials provided to Spanish-speakers to ensure no barriers exist.

The report, based on a survey of 1,798 CHIP and Medicaid families in April and May, found that 25 percent of families renewing coverage for CHIP spoke primarily Spanish at home and that 30 percent of those not renewing coverage spoke Spanish. The difference is statistically significant, the researchers said. There was not a significant difference for Medicaid.

"It is something we want to look very closely at," said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.

Almost two-thirds of children who drop out of Medicaid or CHIP do not obtain other insurance coverage, the report said.

Single-parent families and those with less education were also less likely to renew coverage for CHIP, the report found.

Barbara Best, Texas executive director of the Children's Defense Fund, a national child advocacy organization, said it can be harder for Spanish-speaking families to navigate the application process.

"This survey shows that there have been some real problems with the process, and my experience in working with Spanish-speaking families is that the barriers have been even worse," said Best, whose organization has helped families apply for and renew coverage.

Since a new contractor took over CHIP enrollment in late 2005, both English-speaking and Spanish-speaking families have encountered problems, such as receiving a renewal packet after the application deadline.

"What do you do? Where do you go to appeal that?" asked Best, adding that English-speaking Texans may be better informed than those who do not speak English about options such as calling their state representative's office.

The contractor, Texas Access Alliance, has said it is working with state officials to fix problems.

Spanish-speaking mother Margot Henriquez of Sugar Land said she applied for CHIP coverage for her two sons in December and was rejected — improperly, she thinks. She did not get coverage until August, after the Children's Defense Fund intervened and helped her navigate the system. In the meantime, the stay-at-home mother, whose husband works as a laboratory technician, said she paid more than $150 a month for her older son's two asthma medications. Sometimes, she said, the family had to choose between medical expenses and groceries.

She said the ordeal caused her profound heartache, costing her "lágrimas de sangre" (tears of blood).

Best said Spanish-speaking families have also reported long hold times during calls and disrespectful telephone representatives.

In September, the average Spanish-speaking caller waited more than three times as long as an English-speaking caller (94 seconds versus 30 seconds) to speak to a representative about CHIP, state officials said.

Written materials could also be an issue. Goodman said the commission earlier this year revised English-language letters sent to CHIP and Medicaid families and is translating the materials into Spanish.

"I don't know if that's the most effective way," Goodman said. "Maybe what worked in English, when translated, doesn't work as well."

Austin translator Concepción McCracken is familiar with the challenges that organizations face in adapting materials for different audiences. Sometimes, instead of a translation, what is needed is a completely different material, said McCracken, who has done English/Spanish translations, editing and writing for magazines, a marketing agency and an educational publishing company.

McCracken, who looked at the CHIP/Medicaid renewal materials, found the Spanish-language documents confusing and peppered with misspelled words and other errors.

For example, one sentence said, "Does any member of the family work or?" The rest of the sentence from the English version, "receive training," did not appear in the Spanish document.

She also found inconsistencies, such as the use of two different Spanish translations for the word "disabled" in the same document.

And she pointed out that "child support" — a U.S. legal concept — could have used a more detailed explanation in Spanish than simply the direct translation used in the forms.