HLTH 2110 Week 8 Communication Analysis Example

A Medicaid Renewal Notice Rewritten for the Reader Who Has to Act on It: The Original, the Plain-Language Version and the Difference Measured by Flesch Reading Ease and by Page Structure

Student Name

Walden University

HLTH 2110: Behavioral and Cultural Issues in Healthcare

Instructor Name

Month Day, Year

A Medicaid Renewal Notice Rewritten for the Reader Who Has to Act on It: The Original, the Plain-Language Version and the Difference Measured by Flesch Reading Ease and by Page Structure

The Document and Its Reader

Medicaid agencies send renewal notices every year, and a household that does not respond can lose coverage even when it still qualifies. The notice analyzed here is a composite, written to resemble the style of real agency notices; it is not copied from any state. Its reader is an adult enrollee who may be working, caring for children, reading in a second language or reading with limited skill. In the 2003 National Assessment of Adult Literacy, roughly 36% of U.S. adults scored basic or below basic in health literacy, able to handle only short, simple health texts (Kutner et al., 2006). Berkman et al. (2011), reviewing the research, connected limited health literacy with more emergency visits, less preventive care and poorer outcomes. A renewal notice that such a reader cannot act on is not a neutral document; it decides who keeps coverage.

The Original Notice

IMPORTANT NOTICE REGARDING YOUR MEDICAID ELIGIBILITY REDETERMINATION. In accordance with federal and state regulations, your household's eligibility for continued Medicaid coverage must be redetermined on an annual basis. Our records indicate that the information necessary to complete the redetermination of your eligibility has not been received by this agency. Failure to submit the enclosed Renewal Form, together with all required verification documentation, including but not limited to documentation of household income, residency, and household composition, on or before the date specified below will result in the termination of benefits for all household members. Individuals whose coverage is terminated may reapply; however, a lapse in coverage may occur. If you believe this determination is in error, you have the right to request a fair hearing within ninety (90) days of the date of this notice. Return completed documentation to the address indicated on the reverse. Due date: June 14.

What Makes the Original Hard to Act On

The problems fall into three groups: language, order and missing information.

Language. The notice uses words a reader must translate before acting: "redetermination," "verification documentation," "household composition," "termination of benefits," "lapse." It describes the reader in the third person ("individuals whose coverage is terminated") and uses the passive voice for the agency's own actions ("must be redetermined," "has not been received"), so it is never clear who does what. The key sentence, telling the reader what to send and when, runs to 44 words.

Order. The action the reader must take appears in the middle of the fourth sentence, after a sentence about regulations and a sentence about the agency's records. The due date, the single most important fact, is the last line of the notice. Someone who reads only the opening two sentences learns only that something is being redetermined.

Missing information. The notice does not say when coverage would end, only that it would be terminated. It names "all required verification documentation, including but not limited to" three categories, which tells the reader that the list is incomplete without saying what else is required. It gives no phone number for help and no mention of language assistance.

The Plain-Language Version

Action needed by June 14 to keep your Medicaid.

Your Medicaid ends on June 30 unless you send us your renewal form by June 14.

We check every year to see if you still qualify. We need some papers from you to do this.

What to do: (1) Fill out the renewal form in this envelope. (2) Add a copy of a recent pay stub or other proof of what your household earns. (3) Mail both in the envelope we sent. You do not need a stamp.

If you miss the date, your coverage and your family's coverage will stop. You can apply again, but you may go without coverage for a while.

Questions? Call us free at 1-800-555-0142. We can help in Spanish and other languages.

If you think we made a mistake, you can ask for a hearing. You have 90 days to ask.

The Difference Measured

I measured both versions with the Flesch Reading Ease formula, which scores text from 0 to 100 based on average sentence length and average syllables per word, with higher scores meaning easier text (Flesch, 1948). I also calculated the Flesch-Kincaid grade level, which converts the same two inputs into an approximate school grade. Syllables were counted by a simple rule-based method, so the figures are approximate.

On Flesch's scale, a score near 20 is very difficult, typical of academic writing, while a score in the 80s is easy. The rewrite is about the same length as the original; it is easier because its sentences are half as long and its words are shorter.

Readability scores measure only words and sentences. They do not measure whether a reader can find the action and the deadline, and that is where the larger difference lies.

Table 1

Readability of the Two Versions

The heading, due date and numbered steps were counted as separate sentences in both versions, which lowers the grade estimate for the rewrite more than for the original, so the true gap is somewhat smaller than the table shows.

The Difference in Structure

The rewrite follows the order of the reader's questions: what is happening, what do I do, by when, what happens if I do not and where can I get help. The agency's reason for the notice, which the original placed first, moves to a single short sentence after the action.

Table 2

Where the Reader Finds What They Need

The rewrite moves the deadline and the action from the end of the notice to its first two lines.

Limits of the Rewrite

The plain-language version makes choices an agency would have to check. It names a pay stub as an example of proof of income; if the agency needs other documents, the list must say so in plain words rather than with "including but not limited to." It promises a free return envelope and language help, which the agency must actually provide. And no rewrite can substitute for testing with real readers. Federal agencies have been required since the Plain Writing Act of 2010 (Pub. L. No. 111-274) to write documents the public can understand, but the law does not tell a writer whether a particular reader can act on a particular page. Only asking readers to use the notice, and watching where they hesitate, can do that.

Conclusion

The original notice is accurate and nearly unreadable for the people most likely to receive it. The rewrite says the same things in shorter sentences and shorter words, which raised its Flesch Reading Ease score from about 19 to about 87. More important, it moves the deadline and the action to the top of the page and adds the information a reader needs to act. A renewal notice is a test the household must pass to keep its coverage; the agency decides how hard that test is.

References

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005

Flesch, R. (1948). A new readability yardstick. Journal of Applied Psychology, 32(3), 221-233. https://doi.org/10.1037/h0057532

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S. Department of Education, National Center for Education Statistics. https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483

Plain Writing Act of 2010, Pub. L. No. 111-274, 124 Stat. 2861 (2010).