Interpreter services: American Sign Language (ASL) requests and reimbursement

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American Sign Language (ASL) requests and reimbursement

Interpreter services for Medicaid eligible clients can be requested through the Health Care Authority's (HCA's) current vendor Universal Language Service (Universal).

What do I do if Universal is unable to fulfill my request?

If Universal is unable to fill your ASL interpreter request, you may choose another agency to fill the job and receive reimbursement. Please refer to HCA's ASL FAQ for instructions and reimbursement rates.

When are services covered?

Please note that services will only be covered by HCA if:

  • The client is an eligible Washington Apple Health (Medicaid) client; and
  • Services are an eligible Apple Health medical benefit; and
  • Services are provided by an authorized requester registered with Universal.

For additional background information, please see the following letter:

626 8th Avenue, SE • P.O. Box 45502 • Olympia, Washington 98504-5502

October ___, 2018

SUBJECT: Important update on interpreter services for Apple Health clients who are deaf or hard of hearing

Dear Washington Apple Health (Medicaid) Providers:

We write to inform you of historical issues Health Care Authority (HCA) has had in providing interpreter services to Apple Health clients who are deaf or hard of hearing and to provide an update on our efforts to address those issues.

Historical issues with providing interpreters

Beginning in 2012, HCA contracted with an interpreter services provider who was unable to contract with a sufficient number of sign language interpreters to meet demand for Apple Health appointments. From 2012-2017 there were as few as zero sign language interpreters and only as many as 10 sign language interpreters available to take appointments statewide. In many counties, no sign language interpreters were ever available. Because of this shortage, you may have experienced difficulty in booking sign language interpreters through HCA’s previous interpreter services provider. We believe the fulfillment rate for such requests was at or below 30 percent.

As a result of these fulfillment issues, the U.S. Department of Justice (DOJ) opened an investigation to determine if HCA was meeting its civil rights obligations to assure Apple Health clients who are deaf or hard of hearing have equal access to health care services. HCA entered into a settlement agreement with the DOJ, effective June 11, 2018. View the agreement.

Steps HCA is taking to address these issues

HCA is committed to ensuring effective communication between Apple Health clients who are deaf or hard of hearing and their healthcare providers. We want you to be aware of measures we are taking to help ensure these clients have the interpreter services they need to get high-quality health care:

  • HCA held a competitive procurement for a new interpreter services contract, and entered into a new contract on July 1, 2018 with Universal Language Service (Universal). As of October 22, 2018, Universal has 79 sign language interpreters available to take appointments in Washington State. A map of the number of sign language interpreters available in each county is available on our website.
  • HCA and Universal are continuing efforts to recruit additional sign language interpreters to this program and intend to have more than 100 sign language interpreters signed up by the end of this year.
  • If and when Universal is unable to fill a request for a sign language interpreter, HCA through Universal, will reimburse health care providers for procuring a sign language interpreter independently from the HCA system. In these instances, HCA will pay up to the Office of Deaf and Hard of Hearing (ODHH) established rates, including payments for late cancellations and no shows.
  • HCA has developed a partnership with the ODHH, which serves as the state’s lead agency on deaf and hard of hearing issues, including working with sign language interpreters. Through this partnership, HCA and ODHH will provide outreach to the sign language interpreter community to increase the number of sign language interpreters available to serve Medicaid clients.

How do I request a sign language interpreter for an Apple Health patient who is deaf or hard of hearing?

If your patient or their companion requests a sign language interpreter, or you determine that one is necessary for effective communication during a healthcare appointment, you can obtain a sign language interpreter through HCA’s interpretive services contractor, Universal. To register or request a sign language interpreter, visit Universal’s website.

For information on how to request sign language interpreters or be reimbursed for the cost of a sign language interpreter, please visit the FAQs.

What happens if there are no sign language interpreters available through Universal?

Once you place a request for a sign language interpreter through Universal, you will have the option to determine when you would like to be notified if your job cannot be filled by a sign language interpreter. If you request a sign language interpreter for a given appointment and one is not available, you will immediately receive a notice that no sign language interpreter is availableAt that point you can either:

  • Cancel the request for a sign language interpreter and obtain a sign language interpreter on your own. If you do so, HCA will reimburse you for the costs incurred up to the approved ODHH contract rate. If a private contracted sign language interpreter is not established on the ODHH website, the maximum allowable payment is fifty-five dollars ($55) per hour; or
  • Leave the request pending with Universal, who will continue to try to fill the request up to the time of service. You will be notified whenever the appointment status changes.
  • You can cancel the request at any time and proceed in obtaining your own sign language interpreter with HCA reimbursement, as described in #1.

If you pay for a sign language interpreter outside of the Universal system because no sign language interpreters were available through Universal, you can obtain reimbursement by submitting the following documents to Universal:

  1. Copy of the paid invoice;
  2. Job number from Universal; and
  3. Completed reimbursement voucher.

For more information, please visit the FAQs

Where can I file a complaint or grievance if I encounter problems?

You (or your patients) can visit the following websites for information about how to file a complaint or grievance, including by mail, fax, or email.

Access to care grievances

Universal system or technology complaints

Program complaints

Health care provider responsibility

Please be aware that Apple Health (Medicaid) providers have an independent legal obligation under Title III of the Americans with Disabilities Act (ADA) to ensure all patients, regardless of disability, are able to effectively communicate. This means that Apple Health providers are required to provide an appropriate auxiliary aid or service, including qualified sign language interpreters, where necessary to ensure effective communication for Apple Health clients who are deaf or hard of hearing.  Apple Health Medicaid providers must satisfy this obligation even if HCA’s interpreter services contractor is unable to fulfill your request for a sign language interpreter.

More information about the Apple Health Interpreter Services Program

Should you have any questions or additional concerns, please contact HCA section supervisor Jennifer Inman at 360-725-1738 or


Todd Slettvet 
Section Manager

Medicaid Program Operations and Integrity

By email


MaryAnne Lindeblad, BSN, MPH, Medicaid Director, HCA
Preston W. Cody, Division Director, MPOI, HCA
Jennifer Inman, Section Supervisor, MPOI, HCA
Cynthia Baxley-Raves, ADA Coordinator, HCA