Linguistic Access

Language barriers can inhibit a health care provider’s ability to diagnose and treat patients with limited English proficiency (LEP)—an obstacle to health care that affects millions of people who do not have the ability to proficiently speak, read, write and understand the English language.¹ The Report Card examines states’ commitment to addressing the needs of this population.

Impact of the Affordable Care Act

By 2012, health plans will need to provide all applicants and enrollees with plan information that meets uniform standards, including a requirement that the information is "culturally and linguistically appropriate." Additionally, all health plans sold through the new "Health Insurance Exchanges" that begin operating in 2014 must provide culturally and linguistically appropriate explanations of coverage. Exchange-based plans must also incentivize providers to improve health care quality and reduce disparities through efforts such as increased language access for patients with limited English proficiency (LEP).

Does the state have comprehensive requirements for the provision of appropriate interpretation and translation services to patients with limited English proficiency?

States receive a "meets policy" if they adopt a comprehensive legal requirement to address the language needs of those seeking health care services. States receive a "limited policy" if they have multiple laws that meaningfully remove language barriers in a wide variety of health care settings, or if the state has, at a minimum, a law ensuring access to language assistance for either managed care enrollees or Medicaid participants. States receive a “weak policy” if only a few state laws meaningfully remove language barriers for LEP patients. States receive a "no policy" if laws apply only to very limited settings such as abortion providers, mental health services or assisted living facilities.

The way in which this indicator is evaluated has changed from the 2007 Report Card and therefore there is no comparison to 2007.

State	Strength of Policy	Change from 2007
Alabama	Limited Policy	N/A
Alaska	Weak Policy	N/A
Arizona	Limited Policy	N/A
Arkansas	Limited Policy	N/A
California	Meets Policy	N/A
Colorado	Limited Policy	N/A
Connecticut	Limited Policy	N/A
Delaware	No Policy	N/A
District of Columbia	Limited Policy	N/A
Florida	Limited Policy	N/A
Georgia	No Policy	N/A
Hawaii	Limited Policy	N/A
Idaho	Limited Policy	N/A
Illinois	Meets Policy	N/A
Indiana	Limited Policy	N/A
Iowa	Limited Policy	N/A
Kansas	Weak Policy	N/A
Kentucky	Limited Policy	N/A
Louisiana	Limited Policy	N/A
Maine	Limited Policy	N/A
Maryland	Meets Policy	N/A
Massachusetts	Meets Policy	N/A
Michigan	Limited Policy	N/A
Minnesota	Limited Policy	N/A
Mississippi	Limited Policy	N/A
Missouri	Limited Policy	N/A
Montana	Limited Policy	N/A
Nebraska	Limited Policy	N/A
Nevada	Weak Policy	N/A
New Hampshire	Limited Policy	N/A
New Jersey	Limited Policy	N/A
New Mexico	Limited Policy	N/A
New York	Meets Policy	N/A
North Carolina	Limited Policy	N/A
North Dakota	No Policy	N/A
Ohio	Limited Policy	N/A
Oklahoma	Limited Policy	N/A
Oregon	Meets Policy	N/A
Pennsylvania	Limited Policy	N/A
Rhode Island	Meets Policy	N/A
South Carolina	No Policy	N/A
South Dakota	No Policy	N/A
Tennessee	Limited Policy	N/A
Texas	Limited Policy	N/A
Utah	Limited Policy	N/A
Vermont	Limited Policy	N/A
Virginia	Limited Policy	N/A
Washington	Meets Policy	N/A
West Virginia	No Policy	N/A
Wisconsin	Limited Policy	N/A
Wyoming	Limited Policy	N/A

Policy Indicator Counts

Meets Policy:

8

Limited Policy:

34

Weak Policy:

3

No/Harmful Policy:

6

Better:

0

Same:

0

Worse:

0

Data Source: Linguistic Access Jane Perkins and Mara Youdelman, Summary of State law Requirements Addressing Language Needs in Health Care (National Health Law Program, Jan. 2008); Mara Youdelman, Medicaid and SCHIP Reimbursement Models for Language Services (National Health Law Program, 2009 Update). Considerations include the level of specific guidance provided by a state, the variety of settings included, general statements endorsing the goal of linguistic access, enforcement provisions and the mandatory or optional nature of statutes and regulations. Sources reviewed by the National Health Law Program include administrative regulations regarding hearings on Medicaid and Medicare eligibility.

Footnotes

¹ Edward L. Martinez and others, Language Access in Health Care Statement of Principles: Explanatory Guide (Los Angeles: National Association of Public Hospitals and Health Systems, National Health Law Program, 2010), 8.