Language barriers can be a major obstacle to providing quality healthcare to patients with Limited English Proficiency (LEP). Despite the federal right to language access for patients with LEP in healthcare settings, many healthcare providers are not aware of their responsibility, have not prioritized the issue, or have not been held accountable through the consistent application of these laws. In this article, we will explore the various policy initiatives that have been implemented to improve medical care for patients with LEP, and discuss how healthcare providers can ensure that they are meeting their obligations to provide language assistance services.The Office for Civil Rights (OCR) is responsible for enforcing Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, or national origin in programs or activities receiving federal financial assistance. In 1980, it published a notice stating: “No person may be discriminated against because of their national origin in health and social services programs because they have a primary language other than English.”In response to this, the OCR published extensive policy guidance to help healthcare providers and other recipients of federal funds meet their obligations to people with LEP.
Most states must include language assistance services as a benefit covered by Medicaid, and other states should follow California's example by expanding the requirements for providing language assistance services to health plans and private insurers.
Medicare and Language Assistance Services
Most importantly, Medicare should start paying for language assistance services; a recently published report by the Center on Budget and Policy Priorities and the National Health Law Program provides an overview of some possible options in this area. The report suggests that Medicare should cover language assistance services for all beneficiaries who need them, regardless of their primary language.State Legal Activity on Access to Languages in Healthcare
Overall, state legal activity on access to languages in health care has been a valuable addition to the federal rights of patients with LEP. However, individual laws vary greatly in scope and impact and, together, leave many important areas unprotected. Most states focus primarily or exclusively on pay-per-service outpatient visits, although three states also pay for interpretation for inpatient consultations and managed care, and Kansas only reimburses interpretation services related to Medicaid managed care.California's Language Access Law
California has taken a leading role in addressing language access issues in healthcare.In 2006, California passed a law requiring all health plans and insurers to provide language assistance services to all enrollees who need them. If fully implemented and enforced, this law will grant a strong state right to language assistance services for everyone with private insurance in California.
Resources and Costs
The fourth factor, related to resources and costs, suggests that, among healthcare providers, large organizations, such as hospitals, health plans and health systems, should offer language assistance services on a universal basis. Without widespread reimbursement for language access services in health care, it will ultimately be difficult to attract qualified individuals to the medical interpreter workforce.In conclusion, there are numerous policy initiatives that can help improve medical care for patients with LEP. Healthcare providers must ensure that they are meeting their obligations to provide language assistance services by following the policy guidance issued by the OCR.States should also take steps to expand their requirements for providing language assistance services to health plans and private insurers. Finally, large organizations should offer language assistance services on a universal basis.
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