Journal of Immigrant and Minority Health

, Volume 13, Issue 2, pp 293–298

How Readable are Spanish-Language Medicaid Applications?

  • Julie S. Hansen
  • Lorraine S. Wallace
  • Jennifer E. DeVoe
Original Paper


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.


Literacy Readability Health literacy Medicaid Spanish 


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Julie S. Hansen
    • 1
  • Lorraine S. Wallace
    • 2
  • Jennifer E. DeVoe
    • 3
  1. 1.University of Tennessee Graduate School of MedicineKnoxvilleUSA
  2. 2.Department of Family MedicineUniversity of Tennessee Graduate School of MedicineKnoxvilleUSA
  3. 3.Department of Family MedicineOregon Health and Science UniversityPortlandUSA

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