In May 2010, we downloaded all currently available English-language (n = 50) and Spanish-language (n = 39) Internet-based, state-issued Medicaid/CHIP enrollment applications. We estimated the reading demands of each CHIP enrollment application x201c;Signaturex201d; page using the Lexile Analyzer. We assessed layout characteristics using the User-Friendliness Tool and we evaluated document complexity using the PMOSE/IKIRSCH scale.
On average, Medicaid/CHIP enrollment application x201c;Signaturex201d; pages were written at a high school reading level (English language = 12th- to 13th-grade reading level; Spanish language = 10th- to 11th-grade reading level). Five Medicaid/CHIP enrollment applications (5.6 % ) consistently used a 12-point or larger font size throughout. Most Medicaid/CHIP enrollment applications (n = 83; 93.3 % ) needed x201c;somex201d; or x201c;muchx201d; improvement in the amount of white space. Document complexity ranged from level 3 (moderate) to level 5 (very high), with the majority of Medicaid/CHIP enrollment applications ranked at level 4 (high).
Revisions are required in almost all state Medicaid/CHIP enrollment applications to achieve consistency and to meet standard low-literacy guidelines (e.g., written at a 6th grade or lower reading level and using a font of 12 points or larger). Additionally, to increase access to Medicaid/CHIP for eligible Hispanic children, all states should provide an online Spanish-language version of the Medicaid/CHIP enrollment application.