Cultural Competence

What is Cultural Competence?

People dually eligible for Medicare and Medicaid are diverse in race and ethnicity, language, health condition, disability status, and other characteristics. Providing culturally competent care means respecting individuals' varying beliefs and meeting their social, cultural, and linguistic needs.

Why Strive for Cultural Competence?

Providing culturally competent care that respects the values, beliefs, and needs of individuals can help close gaps in access, quality, and outcomes. Cultural and linguistic competence enables providers and beneficiaries to communicate effectively and take into account diverse perspectives and preferences.

Resources for Integrated Care features resources for providers and plans striving for cultural competence, with emphasis on the following topic areas: 

  • Culturally Competent Long-Term Services and Supports (LTSS): LTSS, including nursing facility services, adult day programs, home care, and personal care services, are a vital part of care for nearly half of full-benefit dually eligible beneficiaries.[1] However, individuals from racial and ethnic minority groups often experience disparities in access, quality, and outcomes in LTSS.[2],[3] By ensuring their services are culturally competent, providers can address these disparities.
  • Culturally Competent Supports for Diverse Family Caregivers: Family caregivers provide physical, emotional, and financial support to individuals who require assistance because of long-term conditions, disabilities, or frailty. To reinforce the important care that family members provide, many plans and providers support family caregivers with training and education, respite care, and counseling. As caregivers come from diverse cultural and linguistic backgrounds, developing services tailored for diverse communities can enhance the impact of such programs.
  • Linguistic Competence: Over 1.8 million individuals dually eligible for Medicare and Medicaid speak a language other than English at home or do not speak English fluently.[4] Limited English Proficiency (LEP) is associated with lower quality of care and decreased access to health care services.[5],[6] Health plans serving dually eligible beneficiaries can play a key role in identifying and communicating language preferences to front-line staff and providers in their network to help remove language barriers to care.

Additional resources for cultural competence

The following websites and resources provide general cultural and linguistic competence information, educational materials and guides, and topic-specific resources for providers and plans serving individuals from diverse cultural backgrounds and/or with limited English proficiency.

[1] MedPac. (2018). Managed care plans for dual-eligible beneficiaries. Retrieved from
[2] Office of the Assistant Secretary for Planning and Evaluation. (2016). Report to Congress: Social Risk Factors and Performance under Medicare's Value Based Purchasing Programs. Retrieved from
[3] Campbell, L. J., Cai X., Gao, S., & Li, Y. (2016). Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011. Gerontology and Geriatric Medicine, 2, 2333721416653561. 
[4] Proctor, K., Wilson-Frederick, S. M., & Haffer, S. C. (2018). The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries. Health Equity. 2(1), 82-89. Retrieved from
[5] Ibid. 
[6] Centers for Medicare and Medicaid Services. (n.d). Providing Language Services to Diverse Populations: Lessons from the Field. Retrieved from