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Regulatory guide · a review aid, not legal advice

42 CFR 438.10: plain-language rules for Medicaid managed care materials

The federal rules for how Medicaid managed care plans write, format and translate member materials, and where the state’s own rules take over.

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In 30 seconds

  • 42 CFR 438.10 is the federal floor for Medicaid managed care materials: easily understood language and format, in at least 12-point font.
  • Materials critical to obtaining services need the prevalent non-English languages, taglines, and the toll-free and TTY numbers.
  • The federal rule sets no reading grade. Grade levels come from each state’s contracts and guidance.

What the rule requires

42 CFR 438.10 applies to states, enrollment brokers and every Medicaid managed care plan. It is the federal floor; states add their own requirements in contracts and guidance.

  • Provide all required information in a manner and format that may be easily understood and is readily accessible.
  • Use easily understood language and format in all written materials, in a font size no smaller than 12 point.
  • Make written materials available in alternative formats and through auxiliary aids and services.
  • Make materials critical to obtaining services (at a minimum provider directories, enrollee handbooks, appeal and grievance notices, and denial and termination notices) available in the prevalent non-English languages.
  • Include taglines in the prevalent non-English languages, in a conspicuously visible font size, explaining how to get written translation or oral interpretation.
  • Use the state’s definitions for managed care terms and its model enrollee handbooks and notices.
  1. 42 CFR 438.10The federal floor
  2. Your state’s managed care contractAdds state requirements
  3. State guidanceAdds state requirements

Applies to

  • States
  • Enrollment brokers
  • Every Medicaid managed care plan
The federal rule is the floor. States add their own requirements on top, in contracts and guidance, so check both before you set a target.

Materials critical to obtaining services

At a minimum these are provider directories, enrollee handbooks, appeal and grievance notices, and denial and termination notices. Each must be available in the prevalent non-English languages in the plan’s service area, in alternative formats on request at no cost, and with taglines and the member services toll-free and TTY numbers.

Reading level

The federal rule sets no reading grade. Grade levels, where they exist, come from each state’s contracts and guidance. Many states name a grade in their managed care contracts or member-materials guides, so check your state’s current contract before you set a target.

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What to check in each notice

A short review list for a denial, termination or handbook update.

  • It uses the state’s definitions for managed care terms and follows its model notice where one exists
  • Body text is at least 12 point; taglines are conspicuously visible
  • Taglines name the prevalent languages and explain how to get translation, interpretation and auxiliary aids
  • The member services toll-free and TTY numbers are on it
  • It meets the grade your state contract sets

Illustrative notice

  1. State terms and model notice
  2. 12-point body text
  3. Taglines
  4. Toll-free and TTY numbers
  5. Your state’s grade

How HealthLiteracyCopilot helps

HealthLiteracyCopilot scores each notice against your target grade and N-PLAT, applies your state’s terms through your glossary, and keeps an approved version of every template so a change is reviewed before it ships.

Your next step

A notice checklist, an annotated before and after, an English and Spanish phrase bank and a language-access checklist. All of it is on one page, with no form.

Open the Medicaid notice kit

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Sources

Questions

Does 42 CFR 438.10 require a sixth-grade reading level?

No. It requires easily understood language and format. Grade levels come from state contracts and guidance.

Which documents need taglines?

Written materials that are critical to obtaining services, at a minimum provider directories, enrollee handbooks, appeal and grievance notices, and denial and termination notices.