ACA Recognizes the Importance of Multilingual Support for Patients

Dimitris Glezos
November 9, 2015
5 min read

One of the most unsuspecting industries is leading the way for a new customer service trend. Thanks to the Affordable Care Act (ACA), the health care industry is redefining how to serve customers, no matter what language they speak.

The reforms put forward by the ACA, also known as Obamacare, require health care providers to provide Limited English Proficient (LEP) patients with access to the information and materials they need to make informed decisions related to health care. This includes making sure payment systems, programs, and documents are properly translated, and that LEP patients have access to interpreters when they receive health care services. These requirements place the health care industry ahead of many others when it comes to reaching customers with multilingual content.

General Language Requirements

Within the Affordable Care Act, there are several provisions that deal exclusively with providing LEP patients with the linguistic access they need, specifically for written documents and oral communications.

Written Documents

The ACA requires that each provider supply all patients with a translated Uniform Glossary and Summary of Benefits Coverage (SBC). In regards to the SBC, the employer and the insurer are responsible for distributing these documents under fully-insured plans. For self-insured plans, the employer is the only one responsible for compiling and handing out these forms. Although it is not explicitly stated, the ACA implies that documents like appeal notices and provision of claims should also be translated to provide comprehensive health care for patients.

Standardized documents like intake forms may also be translated, and providers may benefit from adding translated taglines to the top of commonly used documents, ensuring LEP patients understand the important details of those documents. Health care providers and insurers should also plan to translate their website and digital content into the languages most commonly spoken and read by their patients.

Oral Communication

Individuals with limited English proficiency must be granted access to bilingual staff members or interpreters at each point in the health care process, from registration at a medical facility to financial counseling. This high level of language support ensures that all patients have access to information to confidently make important medical decisions regarding their care.

Selecting Languages for Translation

With more than 6,000 distinct languages spoken around the world, it would be cost prohibitive for providers to translate documents into every language, so the ACA has created guidelines to assist providers in determining which languages they must provide to their patient communities. According to these guidelines, documents should be translated for every LEP patient group that exceeds a minimum of 1,000 people or 10 percent of the health care provider’s population in a specific county. In the situation where 10 percent of the population is less than 50 individuals, it’s not necessary to translate written documents. Instead, translation can be done orally, as needed.

The ACA guidelines also recommend adding a tagline to the top of important health care documents, translating only the headline as opposed to the entire document when cost, resources, or other limitations prevent translations of entire documents. In addition, LEP patients should be provided with a notification that language interpretation is available for free.

Sections of the ACA Relating to Language

Some of the features of the ACA that relate to interpretation and translation include:

    • Section 15574 About Nondiscrimination – According to this section, federal civil rights laws and Title VI don’t allow discrimination due to national origin, color or race – which includes language discrimination. This applies to any program that receives federal funds and any health care exchange.


    • Section 1001 About Notice Requirements – Every health plan and insurance company must create an appeals process for dealing with coverage claims and decisions. The plan or issuer must give enrolled members notices in a language they can understand. Plans with 100 enrolled patients or fewer only need to translate notices if 25 percent of the enrolled patients are primarily literate in another language. Meanwhile, plans with 500 enrolled members need to be translated if 10 percent of the members speak the same, non-English language.


    • Section 1331 About Plain Language Requirements – This section requires each health exchange that wants to be certified under the Affordable Care Act to submit information such as their financial disclosures, denied claims, rating practices, payment policies, cost sharing and other data. Any information provided must be written in plain language that can be understood by patients with limited English proficiency.


  • Section 1001 About Coverage and Benefits – Anyone seeking health care coverage must be provided with a summary of the potential benefits and coverage requirements. This must be written in language that can be understood by the average person, and it may need to be in another format for patients with limited English proficiency. The goal of this provision is to ensure that consumers understand their plans and adequately compare options.

How do Health Care Providers and Insurers Tackle the Requirements?

Although adhering to the multilingual language requirements of the Affordable Care Act may be complex, they ensure that the majority of patients understand their care options and have access to quality care. This improved understanding may help to reduce longer term costs of care, helping to offset the investment providers will need to make in the short run. It’s also important to note that smaller insurance plans and areas with limited LEP populations will be exempt from some of these provisions. An early step for many providers may be to begin working with translation agency or language service provider to identify the right languages and assemble the resources for translation.

For more information about translating digital health care content including websites and mobile apps, reach out to a team member from Transifex and request a quick 30 minute demo. Transifex is a localization automation platform that enables health care providers to raise their standard of care by connecting patients with the information they need to make informed medical decisions.

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Dimitris Glezos
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