Are Hospitals Required to Provide Language Access Services?

You are reading this article because you are not sure that you may have to provide language access services for your patients, right?

You are not the only one, as this is very important topic that is often clouded in confusion. To provide an expert answer, I reached out to the National Health Law Program (NHeLP) for assistance.

The staff at NHeLP did a great job clarifying the requirements for us in very simple terms.

Language access services are generally provided with the help of professional interpreters and translators.

For the purpose of this article, I will assume that you are a health care provider fitting one of the following four categories:

  1. You provide language access services for your patients, but are unsure if you are required to do so.
  2. You don’t provide language access services for your patients, but understand you may be required to do so.
  3. You didn’t provide language access services for a patient and are being threatened with legal action.
  4. A law suit has been filed against your practice for failure to provide language access services by, or on behalf, of the patient.

Regardless of which category fits you, the information below should help clarify your responsibility to provide language access services for your patients.

Unless of course you fall into category 4. If that’s the case, contact your attorney as soon as possible.

Are hospitals required to provide language access services?


Here is why.

Under Title VI of the Civil Rights Act of 1964, discrimination on the basis of race, color or national origin is prohibited.

Therefore, health care providers, including hospitals, that receive federal funding, including Medicare, Medicaid and SCHIP, are required to provide language access services for their patients.

What if health care providers opt out of federal funding?

When federal funds are not in question, health care providers may not be subject to Title VI requirements. However, there may be state laws that require you to provide language access services.

Can health care providers bill the patient for language access services?


If you are receiving federal funding, you are required to cover interpreter costs for all your limited English proficient (LEP) patients, including those with private insurance and no insurance.

State laws may also prohibit you from billing your patients for language access services.

What health care entities are covered under Title VI?

The entities covered by Title VI include hospitals, doctor’s offices, nursing homes, managed care organizations, state Medicaid agencies, home health agencies, health service providers and social service organizations.

How can health care organizations provide language access services to patients?

Health care providers may choose to hire staff interpreters as employees to interpret the most frequently requested languages. Many health care providers typically contract with language service companies to provide language access services.

A language services company can greatly streamline the process by providing scheduling, quality assurance, billing and project management.

What types of language access services should health care providers have readily available to patients?

At a minimum, it is recommended that all health care providers be able to provide on-site interpretation, over-the-phone interpretation and document translation services.

Can health providers use family members, friends or bi-lingual staff to interpret for patients?

It is strongly advised against using family members, friends or bi-lingual staff members to interpret for patients. You could risk malpractice, the cost of which would far outweigh any money you might save by asking friends or family members to help.

In fact, your legal fees in dealing with just one malpractice lawsuit could potentially cover your language access services budget for several years to come.

What about written translation services for patient communication?

According to U.S. Department of Health and Human Services Office for Civil Rights, various types of documents may require translation from English into other languages. Some of the documents include patient forms, discharge instructions and information about the availability of interpreter services.

Learn about the 7 most common document types all health care providers should have translated.

I’d like more information on developing a Language Access Plan for our health care organization.

For more information, check out these publications:

Like this article?

Download it now in PDF format.

Need assistance with language access services in health care settings?

Let’s discuss your specific needs. Contact us.


Dozens of law suits are filed every year against health care facilities for failing to provide language access services.

My advice to you is to set aside a budget for language access services and deliver the best patient experience you can. It will cost you less in the long run.

Share your questions, thoughts and experiences in the comments.

This article was originally published on July 8, 2011 and has been updated on February 8, 2016.

10 replies
  1. Jennifer Franklin
    Jennifer Franklin says:

    I manage a small clinical practice and it seems absurd that we have to provide interpreters at our cost. Many times the cost of interpreters is more than the visit cost. Is there any organization or agency that helps cover these costs?

    • Vic Marcus
      Vic Marcus says:

      Hi, Jennifer,

      I completely understand your frustration. We often have cases in our line of work where the cost of something outweighs the revenue generated from it. I always suggest looking at the big picture. As long as your practice is successful and making money, this is a necessary overhead expense.

      Think about this. If you are not providing interpreters for your patients, you can potentially be sued or fined. You probably don’t want to deal with those kind of headaches as you have a business to manage.

      You should always budget for interpreting services every year. It’s a necessary and often times, mandatory, cost center.

      Feel free to contact me if you have any more questions.



  2. Ali Rouhfar
    Ali Rouhfar says:

    On behalf of a patient :We went to a clinic and asked for an interpreter that has been interpreting for my husband for a long time which was very convenient for us because the interpreter is completely in picture of his medical history. This clinic rejected to request that particular interpreter. The clinic mentioned that the interpretation services agency has governed them not to request an interpreter by name. Since interpreter is a provider and patient has right to chose any interpreter, we want to know if this clinic legally can rejection

    • Vic Marcus
      Vic Marcus says:

      In many cases, the requestor has the ability to request a preferred interpreter by name. However, the agency filling the appointment should strive to assign the most qualified interpreter available. There are no specific laws that mandate any individual to be assigned to an interpreting assignment. Hope this answers your question!

  3. Samantha
    Samantha says:

    I am trying to help local community of LEP individuals have iqual access to care, however there is a lot of residence from providers. How does one approach this sensitive topic and come out with results and the mandatory services?

    • Vic Marcus
      Vic Marcus says:

      Samantha – One way to present this to providers is by having them understand that interpreter services are a part of doing business.

      For example, the providers have to pay for their building lease, utilities, phone service, internet service, medical records information system support fees, etc. The cost of paying for interpreters would be much less than dealing with a malpractice or a Title VI lawsuit later on.

      From my experience, large providers such as hospitals and health systems have no problem paying for interpreter services. It’s only the small providers that have a problem with this.

      The fact is interpreter services are a part of doing business, and it’s a necessary, tax-deductible business expense.

  4. D'Ann Woolverton
    D'Ann Woolverton says:

    My sister in law went to a hospital and was interviewed by someone from psych services. The hospital provided an employee. “That spent many years living in Mexico” to translate. My brother questioned the use of the employee but was told that it was okay to use the employee and that the hospital didn’t have to use a certified translator. My sister in law disputes saying what the translator reports that she said.
    My question is, did the hospital violate the Title VI requirements?

    • Vic Marcus
      Vic Marcus says:

      This would be a good question to ask an attorney specializing in Title VI matters, D’Ann. I only offer an opinion in the articles I write, backed up research.

      It sounds like the hospital tried to provide language access accommodations for your sister-in-law but perhaps didn’t follow best practices in doing so. If this is turning out to be an issue, I recommend taking it up with an attorney. If it doesn’t, I’d ask for the hospital staff to provide accommodations through professional and certified interpreters next time.

      Thanks, D’Ann!

    • Vic Marcus
      Vic Marcus says:

      Laura – The short answer is: Yes. If a hospital receives federal funds, typically through Medicare, it has to provide interpreters/language access services.


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