(HHS, 2000), the Office of Disease Prevention and Health Promotion (ODPHP) has been actively working to raise awareness about health literacy, to identify and coordinate health literacy activities across HHS, to convene HHS agencies to work collaboratively on health literacy, and to identify external partners. In 2000, ODPHP established a partnership with the National Center for Education Statistics of the U.S. Department of Education to develop the health literacy measures that are included in the 2003 National Assessment of Adult Literacy. These data represent the first national measures on health literacy, and will be used to assess the Healthy People 2010 objective. ODPHP has also collaborated with outside organizations on health literacy by including health literacy in its Memoranda of Understanding with several organizations, including the American Medical Association (AMA) and the Academy of General Dentistry.

Centers for Medicare & Medicaid Services (CMS) Individuals considered at highest risk for limited education and low health literacy are the elderly and those with low incomes. Many are enrolled in the Medicare and Medicaid programs administered by the Centers for Medicare & Medicaid Services (CMS). Medicare is a federally run health insurance plan covering nearly 40 million people in the United States who are 65 years of age and older, disabled, or have permanent kidney failure. Medicaid provides health assistance to certain individuals and families with low incomes or resources, and, in contrast to Medicare, is a state-administered program. See below for further information on Medicaid. Both Medicare and Medicaid are complicated and confusing programs, with health literacy issues in enrollment, making choices, patient rights, and terminology (Hudman, 2003; Scala, 2002).

Because CMS runs the Medicare program, it is directly responsible for communication with people covered under Medicare about health insurance coverage, their rights and protections in Medicare, and their health plan options. Communication about the Medicaid program is a function of each state, and CMS works with the states to ensure that people in Medicaid receive the information they need (see below for further information on Medicaid). In both cases, CMS works to ensure that these communications are accurate, reliable, relevant, understandable, and, to the extent possible, culturally appropriate. One way it does so is through the provision of agency-wide communication guidelines and training materials such as “Writing and Designing Print Materials for Beneficiaries: A Guide for State Medicaid Agencies.” CMS also uses consumer research and training, consultation with literacy experts, and communication guidelines to develop materials for consumers that are intended to be easy to navigate and understand through format, design, and wording modifications. Consumer research and testing includes target audience members with lower education



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