Summary of State Law Requirements Addressing Language Needs in Health Care

Executive Summary

About Language Access:

With growing concerns about racial, ethnic, and language disparities in health care and the need for the health care systems to accommodate increasingly diverse patient populations, language access is a matter of national importance. High quality language access services allow individuals with limited English proficiency (LEP) to safely utilize a wider range of health care services. Communication problems increase if language barriers are present, and if proper language support is not available, the risk to patient safety increases exponentially. Research suggests that patients with limited English proficiency are more likely than English-speaking patients to experience negative health outcomes caused by communication errors.

For the purposes of health care, an individual is limited English proficient if they are unable to speak, read, write English at a level necessary for interactions with health care entities/providers. Language access encompasses the array of services that may be provided to an LEP individual to ensure access. Language access can include oral interpreting, written translations, provision of services directly in a non-English language and taglines.

About this Report:

Since the early 2000s, the National Health Law Program has charted the development of state laws on language access. This edition of our 50-state survey provides an update on state activities since 2008.

State laws provide an additional source of protection to federal laws. Indeed, some state legislatures and administrative agencies increasingly recognized the need for linguistically appropriate health care and have adopted measures that require or encourage health and social service providers to overcome language barriers.

As of 2019, every state and the District of Columbia had enacted multiple laws addressing language access. California continues to have the most provisions with 257; however, every state now has at least three such provisions. A limited number of states have enacted comprehensive laws while most states’ provisions focus on a particular type of health care provider, service, payer, or patient group. Some of these laws provide detailed guidance; others note the importance of language access but do not specify activities to improve it. Recent trends include provisions addressing private insurers and marketplaces, interpreter competencies, and cultural competency training for health professionals.

This update to the National health law Program’s prior publications offers citation to and a short description of each state’s statutes and regulations regarding services to LEP persons in health care settings. It supersedes the previous listings published by the National Health Law Program in 2003, 2005, and 2008.

*NHeLP recognizes that the term “mental retardation” is offensive, outdated, and harms the disability community. NHeLP generally uses the term “intellectual disability.”  However, this document uses the term “mental retardation” only to accurately conform to the now-outdated version of federal or state law in effect at the time the document was created. Because we have determined that the document provides valuable information not otherwise available, we continue to provide access to it through our website.

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