Language barriers in healthcare are a critical issue affecting millions of Americans. The HHS Language Access Plan (LAP) aims to eliminate these barriers, ensuring equitable access to healthcare for all individuals, regardless of their proficiency in English. This comprehensive and updated policy provides a strategic approach to address language-related challenges, surpassing existing legal protections and promoting health equity.

Current Lack of Meaningful Language Access, and Barriers Addressed by the Plan

Approximately 8.2% of the U.S. population, or over 25 million individuals, have limited English proficiency (LEP), and face significant barriers in healthcare. These barriers include difficulties in patient-physician communication, obtaining insurance, and understanding medical instructions, leading to poorer health outcomes. Despite their need for HHS-funded programs, LEP individuals often struggle to access these services, worsening health disparities in underserved communities.

Existing laws such as Title VI of the Civil Rights Act, Section 504 of the Rehabilitation Act, Title II of the Americans with Disabilities Act, and Section 1557 of the Affordable Care Act provide critical protections against discrimination based on race, color, national origin, or disability. However, these laws alone are quite broad and have proven insufficient in addressing the complex and evolving needs of LEP populations. They also lack a framework for implementing actionable initiatives to prevent said discrimination in an extremely complex system that is the current healthcare system in the US. The HHS Language Access Plan addresses these insufficiencies and goes beyond these legal frameworks, providing a more comprehensive and proactive approach to language access.

HHS Policy Statement and Purpose

The HHS Language Access Plan articulates the department’s commitment to ensuring that all individuals, regardless of their English proficiency, have meaningful access to quality healthcare services. The policy aims to eliminate language barriers, promote health equity, and enhance the quality of care for LEP individuals. By providing clear guidance and actionable steps, the plan supports HHS operating and staff divisions in developing and implementing their own language access plans tailored to their specific needs and contexts.

The HHS Language Access Plan focuses on improving language access via four key areas:

  1. Web/Public Information: Ensuring that online resources and public information are accessible in multiple languages.
  2. Telephonic Access: Providing telephone interpretation services for telephone communications and availability of in-language telephone helplines to facilitate access to healthcare services.
  3. Program/Benefit Information: Making information about programs and benefits available in various languages and developing a mechanism to process document translation requests to ensure LEP individuals can fully understand and utilize these services.
  4. Federal Funding for Language Services: Allocating federal funds to support the provision of language services, ensuring sustainability and consistency in language access efforts.

The 10 Essential Elements Outlined in the HHS Language Access Plan

The foundation of the updated HHS Language Access Plan includes ten essential elements designed to outline the requirements set forth by the Plan in order to address the four key areas mentioned above. Most importantly, each element provides specific actionable steps agencies must take to achieve the requirements set forth by the Plan. Each element was analyzed and updated from the 2013 Language Access Plan to reflect current needs and advancements. The ten elements are:

  1. Assessment of Language Needs and Capacity: The Plan outlines that agencies must assess the linguistic and cultural identity and needs of their current patient/customer population and determine if their services meet the needs of their population. For instance, the HHS-funded Indian Health Service (IHS) will have a markedly different population with different needs than the Administration of Community Living (ACL). The Plan provides frameworks for how agencies can determine whether individuals may need language assistance and what those needs are. The Plan also delineates that agencies must meet at least once yearly with a language assistance working group to determine how they can best provide language access services, whether that be in the form of multilingual staff, direct in-person interpreters, or contract interpretation and professional translation services.
  2. Interpretation Language Assistance Services: The Plan delineates that HHS agencies must provide appropriate language assistance services (in a variety of ways including face-to-face, virtual, telephone qualified interpreters; auxiliary aids and services; bilingual staff; etc.) free of charge to all individuals. Secondly, agencies must provide a direct point-of-contact to inform individuals that such services are available free of charge, for individuals to reach out to access such services, and for staff to receive appropriate training on providing such services.
  3. Written Translations: The Plan states that agencies must provide all individuals access to vital documents in their native language which must be easily accessible and available in multiple formats. Vital documents include program information, consent forms, complaint forms, applications for programs, notices of rights, notices of loss or decrease of benefits, eligibility criteria, etc. The Plan also states such translations must be translated by qualified interpreters or contractors to ensure information is communicated accurately and clearly.
  4. Policies, Procedures, and Practices: The Plan states that every agency must continuously assess that their policies and procedures effectively provide language access services to its served LEP populations. The Plan delineates that the agency must appoint an official that monitors current policies/procedures, current population needs, and feedback from LEP individuals, and assess whether they adequately meet the needs of the population served. In addition, the designated official must meet with the HHS Language Access Steering Committee and discuss initiatives that have been particularly effective and may be beneficial on a larger scale.
  5. Notice to LEP Individuals: The Plan states that agencies must proactively inform LEP individuals that it will provide no-cost language assistance services. Addressing this element of the plan requires agencies to evaluate their population’s needs (as determined in Element 1) and develop plans to inform individuals of their language access abilities. This includes disseminating information in the form of custom posters, brochures, signs, publicly disseminated documents, and agency websites. Templates of notifications are also provided to agencies in the most common languages. Each year, the agency can submit budget justification for financial assistance in notifying LEP individuals.
  6. Staff Training: The Plan states that each agency must provide adequate training to all necessary staff to deliver language assistance services. Staff must be educated on the agency’s language access resources, who the agency’s assigned point-of-contact is, how to request and work with an interpreter, how to access translated materials for patients, proper and improper use of interpreters, and how to identify someone who needs language assistance.
  7. Assessment and Accountability: Access, Quality, Resources, Reporting: The Plan delineates that agencies must continuously assess and evaluate their current procedures for providing language access and their effectiveness. Agencies must then report to the Language Access Steering Committee their procedures on their progress for implementing and maintaining the plan. This ensures the accountability of agencies in upholding the Plan.
  8. Consultations with Healthcare and Human Services Partners: The Plan states agencies should proactively reach out to the HHS for assistance in determining their population’s needs and what HHS programs and benefits may be beneficial to their served population. This could pave the way for LEP individuals to be aware of HHS programs that may have been previously unknown to the healthcare agency.
  9. Digital and Online Communication: The Plan states that agencies must ensure that digital and online communications are accessible in multiple languages, and that formats for people with disabilities are readily available. This could include implementing readily visible links within webpages to translated webpages, providing sign language interpreters/closed captioning and medical interpretation services at meetings, providing multilingual technical support, developing strategies for dissemination of social media content to multicultural populations, and evaluating the current status of web/digital content with LEP test groups at least every 2 years.
  10. Grant Assurance and Compliance by Recipients of HHS Funding: The Plan states that the recipients of federal funding must be made aware of these requirements and continuously evaluated for their implementation of language access services via their applications and regular review.

HHS Plan Progress Report

The HHS Plan Progress Report provides a comprehensive overview of the achievements and ongoing efforts in implementing the Language Access Plan. Key highlights from the 2023 report include:

  • Significant improvements in the availability of multilingual resources on HHS websites.
  • Enhanced telephonic interpretation services, ensuring LEP individuals can access healthcare services remotely.
  • Increased funding for language services, supporting the sustainability and expansion of language access efforts.
  • Ongoing staff training initiatives to promote cultural and linguistic competency across HHS divisions.

The development and implementation of the HHS Language Access Plan involved extensive stakeholder engagement, including consultations with LEP individuals, community organizations, and healthcare providers. This collaborative approach ensured that the plan addresses the real-world needs and challenges faced by LEP populations.

Conclusion

The HHS Language Access Plan represents a significant step forward in ensuring equitable access to healthcare services for LEP individuals. By addressing language barriers and promoting health equity, the plan aims to improve health outcomes and reduce disparities among underserved communities. The comprehensive and updated approach outlined in the plan, coupled with ongoing efforts to implement and refine language access services, underscores HHS’s commitment to fostering an inclusive and accessible healthcare system for all.