Bridging language barriers: Access to primary care for Medicaid Managed Care patients with limited English proficiency in three metropolitan areas

This secret shopper study compares the wait times for scheduling a first-time primary-care appointment among adults enrolled in Medicaid Managed Care who speak English, Spanish, or Mandarin in the Los Angeles, Houston, and New York Metropolitan Statistical Areas. Primary-care practices in Medicaid Managed Care Organization directories were randomized by language. The objective of the secret shoppers was to schedule first-time primary-care appointments, either in person or via telehealth. We found that the average wait times for Spanish and Mandarin speakers were greater than for English speakers by 3.73 and 14 days in Los Angeles and 7.29 and 2.55 days in Houston, respectively. The average wait time among Spanish and Mandarin speakers was 2.22 and 1.76 days less compared with English speakers in New York. We discuss the importance of policies and provide recommendations to address disparities in health access and use among adults with limited English proficiency. In this innovative mystery shopper study, we compare wait times for a first-time primary-care appointment for patients with limited English proficiency (LEP) who speak Spanish or Mandarin, to English proficient patients in the metropolitan areas of Los Angeles, Houston, and New York. Overall, we identify longer wait times for patients with LEP compared with English speakers, with some variations by specific language and metropolitan area. In addition, patient-clinician language concordance and availability of an interpreter were more common among Spanish compared with Mandarin speakers. These findings underscore the need for language and translation services beyond patient-clinician interactions. We conducted a mystery shopper study that compares wait times to scheduling a first-time primary-care appointment among patients who have Medicaid managed care, and whose primary language is Spanish, Mandarin, or English. This study was conducted in 3 metropolitan areas that have a high concentration of foreign-born populations, including Los Angeles, Houston, and New York. Mystery shoppers called primary-care offices and asked to schedule an appointment as a new patient. Spanish- and Mandarin-speaking patients also inquired about scheduling a primary-care appointment with a bilingual clinician and the availability of an interpreter. Overall, we found longer wait times for patients with limited English proficiency, compared with English speakers, with some variation after considering a patient's language, Spanish or Mandarin, and the geographic area of the primary-care office. We also found that although the availability of bilingual primary-care clinicians and interpreters remains low, Spanish-speaking clinicians and interpreters were more common compared with those that are Mandarin speaking. These results highlight the disparities that continue to exist in the primary-care setting for marginalized populations.