Brief 40 • May 2014 State Estimates of Limited English Proficiency (LEP) by Health Insurance Status Authors Gilbert Gonzales Introduction State Health Access Data Assistance Reducing the number of people without health insurance is the primary goal of the Affordable Center (SHADAC) Care Act (ACA), but individuals with limited English proficiency (LEP) may not receive adequate information in other languages on how to apply and enroll in health insurance plans. In addition, while more individuals with LEP may gain coverage, some are ineligible for Summary Medicaid benefits or premium tax credits due to their immigration status.1 This issue brief provides state-level es- Nevertheless, as more LEP populations gain coverage, more patients with LEP may prefer to timates of people with limited English receive health care services in languages other than English. Providing interpretation services proficiency (LEP) by health insurance to LEP patients reduces language barriers in health care and improves satisfaction, health status from the American Community outcomes and quality of care among LEP populations.2-9 Provisions in the Civil Rights Act Survey. There are an estimated 24.5 million people with LEP in the United and the ACA require federal and state governments to provide interpretation services and States. Over one-third of the LEP pop- information in other languages at no cost to LEP populations seeking medical care or coverage ulation, or 9.5million people with LEP, through Medicaid and the health insurance marketplaces.10-13 Therefore, estimating the number were uninsured in 2012. The remaining of individuals with LEP by type of health insurance coverage will help policymakers and individuals with LEP are covered by pri- providers target language-based initiatives that reach LEP populations. vate and public health insurance plans and remain at risk of not receiving Monitoring changes in coverage for the LEP population at the state level requires access to interpretation services or medical care timely, high quality data on LEP populations. The American Community Survey (ACS) is a in other languages. relatively new source of state-level health insurance coverage estimates, and its large sample size makes it a powerful source of information on relatively small subpopulations, like LEP populations, at the state level. The Appendix at the end of this brief provides detailed information on the ACS and how it compares to other surveys that measure health insurance coverage. Data for this issue brief relies on the most recently available data (2012) in the ACS. | State Health Access Data Assistance Center 1 Limited English Proficiency (LEP) Map 1: Percent of Population 5 Years and Over with Limited English Proficiency (LEP) by Health Insurance Status Maps and tables included in this brief provide state-level estimates for people 5 years and older with limited English proficiency (LEP), meaning that they were unable to speak English “very well.” Language data are not available for children under five, and although there is a large amount of diversity in the languages spoken in the United States, most individuals with LEP speak Spanish.z In 2012, there were an estimated 24.5 million people 5 years old and over with LEP in the United States, or 8.6% of the total population over 5 (Map 1; Table 1). Although individuals with LEP live in every state, they comprise at least 10% of the state population in seven states. More than half of the LEP population resides Map 2: Percent of Uninsured Population in only four states (California, Texas, New York and 5 Years and Over with Limited English Florida). Proficiency (LEP) Approximately 9.5 million people with LEP were 9.5 million people uninsured in 2012 (Map 2; Table 2). People with with limited English LEP comprised one out of five (21.7%) uninsured persons in 2012. LEP is common among uninsured proficiency were populations, as the percent of the uninsured uninsured in 2012 population five years and older with LEP exceeds 10% in 30 states and the District of Columbia. In three states (California, New Jersey, and New York), LEP is found in nearly one-third of the uninsured population 5 years and over. Map 3: Percent of Population 5 Years and LEP is less common among individuals with private Over Covered by Employer-Sponsored health insurance, including employer-sponsored Insurance with Limited English Proficiency insurance (ESI) and insurance purchased directly (LEP) from an insurer. There are approximately 7.3 million people with LEP that have ESI, but this population only makes up 4.5% of the total population over five with ESI (Map 3; Table 3). The LEP population covered by ESI exceeds 10% in only two states— California and Hawaii. 2 | State Health Access Data Assistance Center Map 4: Percent of Population 5 Years and Over Covered by Insurance Purchased Directly from an Insurer with Limited English Proficiency (LEP) Similarly, the LEP population with insurance purchased directly from an insurer exceeds 10% in California and Hawaii (Map 4; Table 4). There are approximately 1.8 million people with LEP covered by insurance purchased directly from an insurer, and they comprise only 5% of the total population with insurance purchased in the individual market. At least 12% of the Medicaid population five years and over are LEP, as there are nearly 5.5 million Medicaid enrollees over five with LEP (Map 5; Table 5) [See Appendix for discussion on the “Medicaid undercount” in the ACS].15 The Medicaid population with LEP exceeds 10% in thirteen states Map 5: Percent of Medicaid Population 5 Years and and exceeds 20% in two states (California and Over with Limited English Proficiency (LEP) New York). The Medicaid population with LEP is also greater than 5% in an additional eleven states, 12% of the Medicaid including some states located in the center of the population reported country, such as Colorado, Nebraska and Minnesota. limited English proficiency Among the 47.4 million people with Medicare, approximately 3.7 million, or 7.7%, are LEP (Map 6; Table 6). The proportion of Medicare beneficiaries with LEP is more common in states with large LEP populations, but nearly two-thirds of Medicare beneficiaries with LEP can be found in four states (California, New York, Florida and Texas). Map 6: Percent of Medicare Population 5 Years and Over with Limited English Proficiency (LEP) Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center (SHADAC). N/A indicates that data were either not available or suppressed because there were fewer than 50 observations in the denominator, or because relative standard errors (RSEs) were larger than 30%. May 2014 | www.shadac.org 3 Conclusion This issue brief estimates that there are approximately public and private health insurance coverage, it is 24.5 million people with limited English proficiency important for health plans and providers to provide (LEP) across the United States. Although individuals language assistance services that improve access and with LEP make up 8.6% of the American population, quality of care for LEP populations. nearly 21.7% of the uninsured population and 12% of the Medicaid population is LEP. About SHADAC The University of Minnesota’s State Health Access Percent with Limited English Proficiency Data Assistance Center (SHADAC) is funded by the (LEP) by Health Insurance Status Robert Wood Johnson Foundation to collect and analyze data to inform state health policy decisions relating to health insurance coverage and access to care. For information on how SHADAC can assist your state with small area estimation or other data issues relevant to state health policy, please contact us LEP is more common at shadac@umn.edu or call 612-624-4802. among the uninsured and Medicaid population who remain at risk Suggested Citation of not receiving Gonzales, G. 2014. “State Estimates of Limited English Proficiency by Health Insurance Status.” interpretation services Issue Brief #40. Minneapolis, MN: State Health or medical care in other Access Data Assistance Center, University of languages Minnesota. Acknowledgment Julie Sonier, Brett Fried, Breanna Allen and Andrea Stronghart provided technical or graphical assistance for this issue brief. Because limited English proficiency is more common among uninsured populations, these groups are at higher risk of not enrolling in Medicaid or health plans offered in the insurance marketplaces, especially if they do not receive adequate information in other languages or are ineligible for Medicaid or premium tax credits due to their unauthorized or recent immigration status (See SHADAC Brief 35).1 Meanwhile, many individuals with LEP already have public and private health insurance and may be at risk of not receiving interpretation services or medical care in other languages. As the ACA continues to expand 4 | State Health Access Data Assistance Center Appendix: Data and Methods Data source and Definitions: Data provided in this brief are from the 2012 American Community Survey (ACS) Public Use Microdata Sample (PUMS) files. The ACS, conducted by the U.S. Census Bureau, is an ongoing general household survey of the entire population (including persons living in group quarters). This mandatory survey—persons are required to respond under law—replaced the long form of the decennial census and provides annual estimates of health insurance coverage for the nation, states, and sub-state geographies. All responses are self-reported. A question on health insurance coverage was added in 2008 that asks about current health insurance coverage for all members of the household, with the following response categories: • Insurance through a current or former employer or union (of this person or another family member) • Insurance purchased directly from an insurance company (of this person or another family member) • Medicare, for people age 65 and over, or people with certain disabilities • Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability • TRICARE or other military health care • VA (including those who have ever enrolled for or used VA health care) • Indian Health Service • Any other type of health insurance or health coverage plan – specify Those reporting no source of coverage or only Indian Health Services are classified as uninsured. Respondents are allowed to report multiple sources of coverage, so estimates of health insurance coverage may not sum to 100%. Some research indicates that there are discrepancies between administrative counts of Medicaid enrollment and estimates from survey data (the “Medicaid undercount”). Nearly all state and federal surveys estimate fewer Medicaid enrollees than is described by enrollment records. Compared to more complicated questionnaires like the National Health Interview Survey (NHIS) or the Medical Expenditure Panel Survey (MEPS), the ACS has a simpler health insurance question which could potentially contribute to misclassifying Medicaid enrollees – it lacks state-specific program names, lacks a verification question, and has a “laundry list” response option. Early analyses by SHADAC provide evidence that the ACS “undercount” is similar to other surveys that measure health insurance coverage.15 Language use is based on two questions in the ACS. First, the ACS asks each person 5 years old and over if they speak a language other than English at home. If other languages were spoken at home, each person indicates how well they speak English based on the following four categories: very well, well, not well, and not at all. Individuals not able to speak English very well are defined as being limited English proficient (LEP). Universe for analysis: We restrict the ACS universe to the population residing in housing units (and not group quarters). All analyses on the limited English proficiency (LEP) population are restricted to individuals 5 years of age and older, as children under 5 years are not asked about their ability to speak English. May 2014 | www.shadac.org 5 References 1. State Health Access Data Assistance Center. 2013. “State estimates of the low-income uninsured not eligible for the ACA Medicaid expansion.” Issue Brief #35. Minneapolis, MN: University of Minnesota. 2. Ponce NA, Hays RD, Cunningham WE. (2006). Linguistic disparities in health care access and health status among older adults. Journal General Internal Medicine, 21(7):786-791. 3. Au M, Taylor EF, Gold M. (2009). Improving Access to Language Services in Health Care. Pinceton, NJ: Matematica Policy Research, Inc. 4. Jacobs E, Chen AH, Karlinher LS, Agger-Gupta N, Mutha S. (2006). The need for more research on language barriers in healthcare: a proposed research agenda. The Milbank Quarterly, 84(1):111-133. 5. Kailiner LS, Perez-Stable EJ, Gildengorin G. (2004). The language divide. The importance of training in the use of interpreters for outpatient practice. Journal of General Internal Medicine, 19(2):175-183. 6. Flores G. (2005). The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62(3):255-299. 7. Karliner LS, Jacobs EA, Chen AH, Mutha S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2): 727-754. 8. Ku L, Flores G. Pay now or pay later: providing interpreter services in health care. Health Affairs, 24(2):435-444. 9. Brach C, Fraser I, Paez K. Crossing the language chasm. Health Affairs, 24(2):424-434. 10. Youdelman, MK. (2008). The medical tongue: U.S. laws and policies on language access. Health Affairs, 27(2):424-433. 11. Title VI of the Civil Rights Act of 1964. 42 U.S.C. §2000d. 12. Executive Order 13166. (2000). Improving Access to Services for Persons with Limited English Proficiency. 13. Patient Protection and Affordable Care Act. (2010). 42 U.S.C. §1001, §1331, § 1557. 14. Ryan C. (2013). Language use in the United States: 2011. Washington, DC: U.S. Census Bureau. 15. State Health Access Data Assistance Center. (2013). Accuracy of Medicaid reporting in the ACS: Preliminary results from linked data. Minneapolis, MN: University of Minnesota. 6 | State Health Access Data Assistance Center TABLE 1: TOTAL POPULATION 5 YEARS AND OVER BY LIMITED ENGLISH PROFICIENCY (LEP) AND BY STATE Limited English Proficient (LEP) Not Limited English Procificient Total Population 5 State Years and Over Estimated Population Percent Estimated Population Percent United States 24,551,760 8.6% 261,537,490 8.6% 286,089,250 Alabama 94,600 2.2% 4,314,110 2.2% 4,408,720 Alaska 28,690 4.4% 624,510 4.4% 653,190 Arizona 553,810 9.3% 5,412,740 9.3% 5,966,540 Arkansas 79,660 3.0% 2,597,040 3.0% 2,676,700 California 6,673,420 19.2% 28,026,690 19.2% 34,700,110 Colorado 297,440 6.3% 4,438,550 6.3% 4,736,000 Connecticut 281,140 8.6% 3,000,510 8.6% 3,281,650 Delaware 41,110 4.9% 795,210 4.9% 836,320 District of Columbia 33,720 6.1% 519,510 6.1% 553,220 Florida 2,074,660 11.6% 15,757,080 11.6% 17,831,740 Georgia 499,130 5.6% 8,489,440 5.6% 8,988,570 Hawaii 161,550 12.8% 1,096,680 12.8% 1,258,230 Idaho 56,070 3.9% 1,398,680 3.9% 1,454,750 Illinois 1,109,310 9.4% 10,658,510 9.4% 11,767,820 Indiana 191,660 3.2% 5,733,790 3.2% 5,925,450 Iowa 76,250 2.8% 2,700,340 2.8% 2,776,590 Kansas 117,960 4.5% 2,490,950 4.5% 2,608,910 Kentucky 74,070 1.9% 3,903,790 1.9% 3,977,860 Louisiana 104,800 2.5% 4,060,870 2.5% 4,165,670 Maine 19,190 1.6% 1,206,910 1.6% 1,226,100 Maryland 344,550 6.4% 5,036,080 6.4% 5,380,630 Massachusetts 530,070 8.8% 5,506,070 8.8% 6,036,140 Michigan 292,840 3.2% 8,794,120 3.2% 9,086,960 Minnesota 213,880 4.4% 4,685,470 4.4% 4,899,350 Mississippi 29,750 1.1% 2,659,310 1.1% 2,689,060 Missouri 118,590 2.2% 5,358,210 2.2% 5,476,800 Montana 9,450 1.0% 908,290 1.0% 917,740 Nebraska 91,110 5.5% 1,579,930 5.5% 1,671,040 Nevada 308,880 12.2% 2,230,940 12.2% 2,539,830 New Hampshire 29,890 2.5% 1,185,190 2.5% 1,215,080 New Jersey 1,003,730 12.3% 7,150,590 12.3% 8,154,320 New Mexico 165,420 8.7% 1,736,300 8.7% 1,901,710 New York 2,418,030 13.6% 15,413,190 13.6% 17,831,230 North Carolina 446,760 5.0% 8,439,790 5.0% 8,886,550 North Dakota 8,530 1.4% 622,700 1.4% 631,220 Ohio 243,680 2.3% 10,310,200 2.3% 10,553,880 Oklahoma 137,990 4.0% 3,310,050 4.0% 3,448,040 Oregon 215,000 6.0% 3,366,890 6.0% 3,581,890 Pennsylvania 466,100 4.0% 11,158,150 4.0% 11,624,250 Rhode Island 83,810 8.8% 868,630 8.8% 952,440 South Carolina 118,110 2.8% 4,172,350 2.8% 4,290,460 South Dakota 13,700 1.9% 726,790 1.9% 740,490 Tennessee 150,340 2.6% 5,754,840 2.6% 5,905,170 Texas 3,288,590 14.0% 20,255,390 14.0% 23,543,970 Utah 136,930 5.4% 2,416,510 5.4% 2,553,450 Vermont 7,150 1.3% 563,190 1.3% 570,350 Virginia 422,290 5.7% 7,018,100 5.7% 7,440,390 Washington 496,930 7.9% 5,818,980 7.9% 6,315,910 West Virginia 10,390 0.6% 1,691,700 0.6% 1,702,090 Wisconsin 168,170 3.2% 5,060,420 3.2% 5,228,590 Wyoming 12,890 2.5% 513,230 2.5% 526,120 Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center (SHADAC). May 2014 | www.shadac.org 7 TABLE 2: UNINSURED POPULATION 5 YEARS AND OVER BY LIMITED ENGLISH PROFICIENCY (LEP) AND BY STATE Limited English Proficient (LEP) Not Limited English Procificient Total Population 5 State Years and Over Without Estimated Population Percent Estimated Population Percent Health Insurance United States 9,547,420 21.7% 34,385,510 78.3% 43,932,930 Alabama 48,040 7.8% 564,520 92.2% 612,560 Arizona 244,440 22.8% 825,640 77.2% 1,070,080 Arkansas 34,150 7.5% 424,100 92.6% 458,250 California 2,395,770 36.9% 4,089,990 63.1% 6,485,770 Colorado 125,730 17.6% 586,990 82.4% 712,720 Connecticut 94,420 29.8% 222,400 70.2% 316,820 Delaware 15,050 20.5% 58,430 79.5% 73,480 District of Columbia 5,990 19.0% 25,550 81.0% 31,540 Florida 915,720 25.0% 2,749,290 75.0% 3,665,010 Georgia 274,670 15.8% 1,462,720 84.2% 1,737,390 Hawaii 16,030 19.1% 68,150 81.0% 84,180 Idaho 29,150 12.0% 214,670 88.0% 243,830 Illinois 425,630 26.5% 1,177,970 73.5% 1,603,600 Indiana 85,060 9.6% 802,910 90.4% 887,970 Iowa 27,640 11.4% 214,090 88.6% 241,730 Kansas 49,880 14.5% 294,440 85.5% 344,320 Kentucky 29,940 5.3% 530,570 94.7% 560,510 Louisiana 52,940 7.2% 678,610 92.8% 731,540 Maryland 143,360 25.1% 426,950 74.9% 570,310 Massachusetts 57,390 23.5% 186,770 76.5% 244,160 Michigan 76,010 7.0% 1,014,400 93.0% 1,090,410 Minnesota 65,010 15.5% 354,370 84.5% 419,390 Mississippi 14,980 3.1% 466,490 96.9% 481,470 Missouri 49,150 6.3% 736,820 93.8% 785,980 Montana 4,110 2.4% 164,690 97.6% 168,800 Nebraska 37,140 19.2% 156,380 80.8% 193,520 Nevada 143,240 25.2% 425,720 74.8% 568,960 New Hampshire 8,220 5.9% 131,960 94.1% 140,190 New Jersey 387,610 35.6% 701,530 64.4% 1,089,150 New Mexico 67,690 18.2% 303,430 81.8% 371,120 New York 652,680 32.0% 1,385,990 68.0% 2,038,660 North Carolina 264,590 17.4% 1,260,420 82.7% 1,525,010 Ohio 84,970 6.7% 1,179,850 93.3% 1,264,820 Oklahoma 82,220 12.5% 576,550 87.5% 658,770 Oregon 78,370 14.5% 460,960 85.5% 539,330 Pennsylvania 130,200 11.3% 1,020,870 88.7% 1,151,070 Rhode Island 27,830 25.0% 83,400 75.0% 111,220 South Carolina 66,970 9.1% 671,060 90.9% 738,030 Tennessee 77,120 9.1% 773,590 90.9% 850,710 Texas 1,630,790 29.4% 3,909,470 70.6% 5,540,260 Utah 70,000 18.8% 302,640 81.2% 372,630 Virginia 175,330 18.3% 784,470 81.7% 959,800 Washington 188,810 20.9% 716,610 79.2% 905,420 Wisconsin 61,700 12.4% 434,880 87.6% 496,580 Wyoming 7,360 8.4% 80,210 91.6% 87,570 Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center (SHADAC). 8 | State Health Access Data Assistance Center TABLE 3: POPULATION 5 YEARS AND OVER WITH EMPLOYER-SPONSORED INSURANCE (ESI) BY LIMITED ENGLISH PROFICIENCY (LEP) AND BY STATE Limited English Proficient (LEP) Not Limited English Procificient Total Population 5 State Years and Over with ESI Estimated Population Percent Estimated Population Percent United States 7,299,140 4.5% 156,365,200 95.5% 163,664,340 Alabama 29,890 1.2% 2,517,780 98.8% 2,547,660 Alaska 8,190 2.0% 396,130 98.0% 404,320 Arizona 129,120 4.2% 2,921,330 95.8% 3,050,450 Arkansas 33,460 2.4% 1,335,420 97.6% 1,368,870 California 1,967,720 10.9% 16,073,040 89.1% 18,040,760 Colorado 85,020 3.1% 2,700,990 97.0% 2,786,010 Connecticut 100,780 4.8% 2,003,050 95.2% 2,103,830 Delaware 15,300 2.8% 528,280 97.2% 543,580 District of Columbia 13,530 3.9% 331,340 96.1% 344,870 Florida 486,130 5.7% 8,076,580 94.3% 8,562,710 Georgia 144,020 2.9% 4,871,020 97.1% 5,015,030 Hawaii 95,850 11.0% 773,740 89.0% 869,580 Idaho 15,330 1.9% 778,740 98.1% 794,070 Illinois 380,140 5.5% 6,590,710 94.6% 6,970,860 Indiana 59,960 1.7% 3,499,570 98.3% 3,559,530 Iowa 33,260 1.9% 1,698,980 98.1% 1,732,240 Kansas 46,700 2.9% 1,565,230 97.1% 1,611,930 Kentucky 28,690 1.3% 2,249,080 98.7% 2,277,770 Louisiana 24,970 1.2% 2,120,090 98.8% 2,145,050 Maine 8,120 1.2% 685,700 98.8% 693,820 Maryland 126,260 3.5% 3,482,350 96.5% 3,608,610 Massachusetts 182,620 4.6% 3,818,670 95.4% 4,001,290 Michigan 117,850 2.1% 5,445,950 97.9% 5,563,800 Minnesota 75,000 2.4% 3,090,250 97.6% 3,165,250 Mississippi 9,510 0.7% 1,306,780 99.3% 1,316,290 Missouri 43,980 1.4% 3,119,360 98.6% 3,163,340 Montana 3,050 0.7% 464,110 99.4% 467,160 Nebraska 35,240 3.4% 1,003,410 96.6% 1,038,650 Nevada 118,410 8.4% 1,285,850 91.6% 1,404,260 New Hampshire 13,460 1.7% 796,910 98.3% 810,370 New Jersey 334,720 6.4% 4,885,070 93.6% 5,219,790 New Mexico 39,480 4.2% 897,930 95.8% 937,410 New York 678,230 6.5% 9,822,430 93.5% 10,500,660 North Carolina 102,250 2.1% 4,737,300 97.9% 4,839,550 Ohio 88,360 1.4% 6,426,950 98.6% 6,515,310 Oklahoma 35,690 1.9% 1,813,480 98.1% 1,849,170 Oregon 76,660 3.8% 1,918,740 96.2% 1,995,400 Pennsylvania 169,280 2.4% 7,025,300 97.7% 7,194,580 Rhode Island 26,770 4.6% 560,440 95.4% 587,210 South Carolina 32,150 1.4% 2,322,780 98.6% 2,354,930 South Dakota 5,500 1.3% 426,420 98.7% 431,910 Tennessee 41,560 1.3% 3,247,220 98.7% 3,288,780 Texas 773,930 6.3% 11,441,950 93.7% 12,215,880 Utah 43,200 2.6% 1,632,470 97.4% 1,675,670 Vermont 3,160 1.0% 330,770 99.1% 333,930 Virginia 170,450 3.5% 4,760,200 96.5% 4,930,650 Washington 169,080 4.4% 3,646,200 95.6% 3,815,290 West Virginia 5,780 0.6% 990,840 99.4% 996,620 Wisconsin 65,200 2.0% 3,239,470 98.0% 3,304,660 Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center (SHADAC). May 2014 | www.shadac.org 9 TABLE 4: POPULATON 5 YEARS AND OVER WITH INSURANCE PURCHASED DIRECTLY FROM AN INSURER BY LIMITED ENGLISH PROFICIENCY (LEP) AND BY STATE Limited English Proficient (LEP) Not Limited English Procificient Total Population 5 Years and Over With State Insurance Purchased Estimated Population Percent Estimated Population Percent Directly From Insurer United States 1,802,440 5.0% 33,972,880 95.0% 35,775,320 Alabama 7,760 1.2% 616,760 98.8% 624,520 Arizona 29,320 3.7% 753,650 96.3% 782,970 Arkansas 3,930 1.2% 336,440 98.9% 340,370 California 464,690 11.7% 3,503,220 88.3% 3,967,910 Colorado 20,420 3.1% 642,430 96.9% 662,850 Connecticut 21,900 5.4% 385,520 94.6% 407,420 Delaware 1,800 2.0% 86,650 98.0% 88,450 District of Columbia 3,310 4.4% 71,490 95.6% 74,800 Florida 152,010 6.3% 2,254,900 93.7% 2,406,910 Georgia 29,880 3.1% 940,530 96.9% 970,410 Hawaii 22,830 13.3% 148,370 86.7% 171,200 Idaho 3,780 1.5% 243,690 98.5% 247,470 Illinois 98,520 6.7% 1,375,210 93.3% 1,473,730 Indiana 15,660 2.2% 687,220 97.8% 702,880 Iowa 7,510 1.5% 508,930 98.6% 516,440 Kansas 11,070 2.9% 376,120 97.1% 387,190 Kentucky 5,460 1.1% 478,750 98.9% 484,210 Louisiana 10,790 2.1% 503,710 97.9% 514,500 Maine 3,620 2.1% 165,270 97.9% 168,890 Maryland 28,970 4.4% 624,070 95.6% 653,040 Massachusetts 53,480 7.0% 709,300 93.0% 762,790 Michigan 32,440 2.9% 1,099,250 97.1% 1,131,680 Minnesota 14,330 1.8% 773,150 98.2% 787,480 Mississippi 1,940 0.6% 339,610 99.4% 341,550 Missouri 10,640 1.4% 761,240 98.6% 771,890 Nebraska 7,470 2.7% 271,420 97.3% 278,890 Nevada 19,500 7.1% 255,460 92.9% 274,960 New Hampshire 4,010 2.8% 138,420 97.2% 142,420 New Jersey 73,130 7.7% 874,790 92.3% 947,920 New Mexico 8,940 4.6% 184,140 95.4% 193,080 New York 187,940 9.5% 1,801,830 90.6% 1,989,760 North Carolina 24,490 2.1% 1,169,680 98.0% 1,194,170 Ohio 30,320 2.5% 1,193,520 97.5% 1,223,840 Oklahoma 4,350 1.0% 421,340 99.0% 425,690 Oregon 21,020 3.9% 523,840 96.1% 544,860 Pennsylvania 53,130 3.1% 1,642,580 96.9% 1,695,710 Rhode Island 5,890 5.1% 110,160 94.9% 116,050 South Carolina 8,200 1.5% 522,570 98.5% 530,770 Tennessee 10,250 1.3% 777,170 98.7% 787,420 Texas 173,510 7.4% 2,159,940 92.6% 2,333,450 Utah 8,540 2.9% 285,940 97.1% 294,470 Virginia 42,100 4.3% 941,720 95.7% 983,820 Washington 42,530 5.0% 816,630 95.1% 859,160 Wisconsin 11,270 1.6% 700,290 98.4% 711,560 Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center (SHADAC). 10 | State Health Access Data Assistance Center TABLE 5: MEDICAID POPULATION 5 YEARS AND OVER BY LIMITED ENGLISH PROFICIENCY (LEP) AND BY STATE Not Limited English Limited English Proficient (LEP) Total Population 5 Procificient State Years and Over with Estimated Population Percent Percent Medicaid United States 5,466,280 12.0% 88.0% 45,548,440 Alabama 10,960 1.5% 98.5% 748,660 Alaska 6,570 7.4% 92.7% 89,420 Arizona 135,270 12.8% 87.3% 1,061,070 Arkansas 10,040 2.1% 98.0% 489,760 California 1,670,240 26.8% 73.3% 6,244,350 Colorado 58,620 9.5% 90.5% 614,790 Connecticut 62,440 12.1% 87.9% 517,160 Delaware 9,950 6.2% 93.8% 161,600 District of Columbia 12,130 8.7% 91.4% 140,160 Florida 397,220 14.5% 85.5% 2,746,840 Georgia 51,060 3.8% 96.2% 1,345,020 Hawaii 32,380 16.9% 83.2% 192,160 Idaho 8,050 4.1% 95.9% 197,320 Illinois 191,810 10.4% 89.7% 1,852,940 Indiana 31,060 3.9% 96.1% 803,310 Iowa 11,700 2.8% 97.2% 411,400 Kansas 11,310 3.8% 96.2% 296,430 Kentucky 11,070 1.7% 98.4% 671,000 Louisiana 14,050 1.7% 98.3% 824,180 Maine 5,600 2.1% 97.9% 266,900 Maryland 45,530 6.3% 93.8% 728,110 Massachusetts 244,430 19.2% 80.8% 1,271,610 Michigan 70,970 4.4% 95.6% 1,610,580 Minnesota 58,560 9.2% 90.8% 638,510 Mississippi 3,370 0.6% 99.4% 583,390 Missouri 15,610 2.1% 97.9% 743,660 Nebraska 11,310 6.3% 93.8% 180,840 Nevada 24,590 9.4% 90.6% 261,190 New Hampshire 4,810 3.9% 96.2% 124,790 New Jersey 178,850 17.6% 82.4% 1,016,690 New Mexico 39,920 10.4% 89.6% 383,780 New York 869,910 23.6% 76.4% 3,691,700 North Carolina 58,970 4.3% 95.7% 1,377,970 Ohio 38,360 2.4% 97.7% 1,629,480 Oklahoma 13,470 2.7% 97.4% 508,080 Oregon 43,040 7.8% 92.2% 551,720 Pennsylvania 111,600 6.2% 93.8% 1,798,710 Rhode Island 23,810 15.2% 84.8% 157,000 South Carolina 9,550 1.4% 98.6% 694,470 Tennessee 20,310 2.0% 98.0% 1,005,140 Texas 644,930 18.1% 81.9% 3,567,110 Utah 15,090 5.9% 94.1% 255,790 Virginia 34,180 4.8% 95.2% 707,730 Washington 100,020 11.7% 88.3% 854,710 Wisconsin 32,800 4.1% 95.9% 798,880 Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center May 2014 | www.shadac.org 11 TABLE 6: MEDICARE POPULATION 5 YEARS AND OVER BY LIMITED ENGLISH PROFICIENCY (LEP) AND BY STATE Limited English Proficient (LEP) Not Limited English Procificient Total Population 5 State Years and Over With Estimated Population Percent Estimated Population Percent Medicare United States 3,664,160 7.7% 43,731,730 92.3% 47,395,890 Alabama 3,960 0.5% 845,950 99.5% 849,900 Alaska 4,550 6.8% 62,280 93.2% 66,830 Arizona 79,740 7.6% 966,420 92.4% 1,046,160 Arkansas 3,760 0.7% 528,540 99.3% 532,300 California 1,078,950 22.0% 3,818,010 78.0% 4,896,970 Colorado 35,720 5.4% 623,050 94.6% 658,770 Connecticut 46,580 8.4% 505,690 91.6% 552,270 Delaware 3,930 2.5% 153,180 97.5% 157,100 District of Columbia 3,450 4.6% 72,100 95.4% 75,550 Florida 441,820 11.7% 3,328,570 88.3% 3,770,390 Georgia 33,710 2.6% 1,284,970 97.4% 1,318,680 Hawaii 36,570 17.0% 178,050 83.0% 214,610 Idaho 5,040 2.1% 234,590 97.9% 239,630 Illinois 145,360 8.1% 1,656,580 91.9% 1,801,940 Indiana 18,160 1.8% 974,830 98.2% 992,990 Iowa 3,990 0.8% 496,900 99.2% 500,880 Kansas 9,170 2.2% 416,900 97.9% 426,060 Kentucky 4,970 0.7% 743,580 99.3% 748,550 Louisiana 17,520 2.5% 675,120 97.5% 692,640 Maine 5,480 2.1% 256,050 97.9% 261,530 Maryland 36,060 4.5% 769,130 95.5% 805,190 Massachusetts 106,570 10.5% 908,210 89.5% 1,014,780 Michigan 52,520 3.2% 1,600,620 96.8% 1,653,140 Minnesota 20,700 2.7% 753,540 97.3% 774,240 Mississippi 1,840 0.4% 491,860 99.6% 493,690 Missouri 10,400 1.0% 993,940 99.0% 1,004,350 Montana 1,350 0.8% 171,700 99.2% 173,050 Nebraska 5,270 1.9% 266,320 98.1% 271,580 Nevada 31,780 8.2% 356,750 91.8% 388,530 New Hampshire 5,810 2.7% 207,290 97.3% 213,100 New Jersey 167,520 12.7% 1,147,660 87.3% 1,315,170 New Mexico 37,020 11.0% 300,000 89.0% 337,020 New York 461,060 15.7% 2,473,210 84.3% 2,934,270 North Carolina 18,140 1.2% 1,533,170 98.8% 1,551,310 Ohio 36,610 1.9% 1,849,830 98.1% 1,886,440 Oklahoma 9,270 1.5% 606,140 98.5% 615,410 Oregon 21,710 3.4% 614,500 96.6% 636,210 Pennsylvania 81,560 3.7% 2,115,480 96.3% 2,197,040 Rhode Island 15,490 8.9% 158,570 91.1% 174,060 South Carolina 9,280 1.2% 797,650 98.9% 806,930 Tennessee 11,750 1.1% 1,074,980 98.9% 1,086,730 Texas 407,530 13.1% 2,694,290 86.9% 3,101,820 Utah 11,320 3.8% 286,210 96.2% 297,530 Vermont 2,330 2.0% 111,920 98.0% 114,250 Virginia 40,790 3.5% 1,127,440 96.5% 1,168,240 Washington 57,530 5.8% 931,560 94.2% 989,080 West Virginia 1,280 0.3% 374,110 99.7% 375,380 Wisconsin 14,980 1.7% 881,070 98.3% 896,040 Source: 2012 American Community Survey, as analyzed by the State Health Access Data Assistance Center (SHADAC). 12 | State Health Access Data Assistance Center Our Website shadac.org provides valuable research and resources on health insurance coverage in states, data collection methods, and state health policy. Here you will find: Data Center Technical Assistance Resources A web-based interactive tool SHADAC offers technical shadac.org provides many resources for allowing users to customize assistance to states relating to analysts to understand the technical and tables and graphs of health implementation of the Affordable policy-relevant issues associated with insurance coverage estimates Care Act and is a designated measuring health insurance coverage from the Current Population technical assistance resource for and access to care. Survey (CPS) and the American the RWJF State Health Reform Community Survey (ACS). Assistance Network. Bridging the gap between research and policy @ www.shadac.org Sign up to receive our newsletter and updates at www.shadac.org @shadac Sign up to receive our newsletter and updates at www.shadac.org Bridging the gap between research and policy @ www.shadac.org Funded by a grant from The Robert Wood Johnson Foundation ©2014 Regents of the University of Minnesota. 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