Language access in health & mental health care

Title VI of the Civil Rights Act of 1964 provides that no person “shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” The HHS Office for Civil Rights states that Title VI and Section 1557 “require these programs to provide language access services (LAS) free of charge.”

A Justice Department notice of April 2025 states: “Consistent with E.O. 14224, the Department rescinded its 2002 DOJ LEP Guidance on March 21, 2025.” Executive Order 14224, which revoked Executive Order 13166, provides that “nothing in this order, however, requires or directs any change in the services provided by any agency.” The Attorney General’s memorandum of 14 July 2025 stated that “[w]ithin 180 days, the Department will issue new guidance, for public comment”; as of 28 September 2026 no such guidance had been published. lep.gov now leads to a Justice Department notice: “To implement Executive Order 14224, and pursuant to the Attorney General’s implementation memo, the Department of Justice has temporarily suspended the operations of lep.gov, pending an internal review. These materials will be replaced when new guidance is issued.”

Beginning with the Justice Department in December 2025, federal agencies have repealed the disparate-impact provisions of their Title VI regulations. The HHS rule of 24 July 2026 “removes and reserves 45 CFR 80.3(b)(2),” and HHS “will not pursue Title VI disparate-impact liability against its Federal funding recipients.” 45 CFR 80.3(b)(2) now reads “[Reserved].” In its announcement of 23 July 2026, HHS stated: “OCR will continue to investigate complaints, conduct compliance reviews, seek voluntary resolutions where appropriate, and take enforcement action to combat intentional race-, color-, and national-origin-based discrimination. OCR will also consider statistical disparities, along with other evidence, to evaluate whether intentional discrimination occurred.”

Title VI remains in force, and complaints under it can still be filed. The specific language access requirements for health care are those of Section 1557, described in the next section. Free and low-cost legal services are listed on the map of legal services.

Section 1557 of the Affordable Care Act prohibits discrimination in health programs and activities that receive federal financial assistance, including most hospitals, many clinics and marketplace insurers. Under the 2024 final rule, language assistance services “must be provided free of charge, be accurate and timely,” and a covered entity “must offer a qualified interpreter” (45 CFR 92.201). The same section provides that a covered entity must not “[r]equire an individual with limited English proficiency to provide their own interpreter, or to pay the cost of their own interpreter,” and it permits reliance on a minor child to interpret only in an emergency. A notice of the availability of language assistance must be provided “in English and at least the 15 languages most commonly spoken by individuals with limited English proficiency of the relevant State or States,” including “[a]t a conspicuous location on the covered entity’s ... website” (45 CFR 92.11). HHS summarizes these rights in a fact sheet available in 19 language versions: “You are not required to bring your own interpreter, pay for an interpreter, or rely on a child or family member to interpret for you.”

A federal court vacated parts of the 2024 rule in October 2025. The HHS notice of 2 June 2026 lists the vacated provisions, which concern gender identity, and states: “The other provisions of the Section 1557 Rule remain in force.” In its 2026 regulatory agenda, HHS states that it “would amend its regulations implementing Section 1557 of the Affordable Care Act to conform more closely with statutory text, Executive Orders 14219, 14168, and 14192, court decisions, and reduce unnecessary burdens,” and it lists February 2027 as the target date for a proposed rule. The entry does not identify the provisions that would change, and as of 28 September 2026 no proposed rule had been published.

Under 45 CFR part 92, “A covered entity that employs fifteen or more persons must designate and authorize at least one employee, a ‘Section 1557 Coordinator’”; a patient may ask a provider for this coordinator. The HHS complaint process states that a complaint must “[b]e filed within 180 days of when you knew that the act or omission complained of occurred,” that “OCR may extend the 180-day period if you can show ‘good cause,’” and that “[l]anguage assistance services for OCR matters are available and provided free of charge.” Notes of the date, the place and the names of the staff involved support a complaint. Free and low-cost legal services are listed on the map of legal services.

Section 504 of the Rehabilitation Act and the Americans with Disabilities Act require effective communication with people who are Deaf or hard of hearing, which often involves a qualified sign language interpreter. ADA.gov states that covered entities “cannot require a person to bring someone to interpret for him or her,” and under 28 CFR 36.301(c) a public accommodation “may not impose a surcharge on a particular individual with a disability ... to cover the costs of measures, such as the provision of auxiliary aids.” For Video Remote Interpreting (VRI), ADA.gov lists the following standards: “real-time, full-motion video and audio,” “a sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers,” “a clear, audible transmission of voices,” and “adequate staff training.” ADA.gov also notes that “VRI will not be effective in all circumstances,” and HRSA’s guidance states that “the use of in-person interpreting is an industry best practice.”

The National Standards for Culturally and Linguistically Appropriate Services (CLAS), maintained by the HHS Office of Minority Health, are described as “a set of 15 action steps” for health and health care organizations. Standard 5 reads: “Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.” Standard 7 reads: “Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided.” A Behavioral Health Implementation Guide applies the standards to mental health and substance use settings. According to a 2023 summary by the Network for Public Health Law, some states require CLAS-aligned cultural competency training for health professionals; the Policy map shows these states.

According to Medicaid.gov, “Longstanding CMS policy permits reimbursement at the standard 50% federal matching rate for translation/interpretation activities that are claimed as an administrative expense.” States may also claim a higher matching rate (75% under Medicaid) for translation and interpretation “related to enrollment, retention and use of services” for “children of families for whom English is not their primary language, and family members of these children.” The higher rate is a state option, and states differ in whether they use it.

Section 71109 of Public Law 119-21, the 2025 budget law, provides that, “beginning on October 1, 2026,” federal Medicaid payment is limited to citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and people who reside in the United States under a Compact of Free Association. In a letter to state health officials of 8 April 2026 (SHO #26-001), CMS explains that federal funding “will no longer be available for full Medicaid or CHIP benefits furnished to qualified noncitizens who are not also FFP-eligible noncitizens (e.g., asylees, refugees, parolees, or victims of trafficking).” The letter states that the new provision “did not make any changes to coverage of emergency Medicaid ... nor to coverage under the CHIPRA 214 option” (the state option to cover lawfully residing children and pregnant people), that “39 states, the District of Columbia, and three territories have elected the CHIPRA 214 option” (list of states), and that states “must provide advance notice of adverse action, including the right to a Medicaid fair hearing or CHIP review, before terminating coverage.” A lawsuit in Washington State, Neighborhood House v. HHS, challenges how the change applies to refugees and others who receive SSI; a hearing on a preliminary injunction is scheduled for 29 September 2026, and as of 28 September 2026 no court had put the change on hold.

Separately, the public charge rule took effect on 18 September 2026. Under the rule, DHS “will consider the receipt of any means tested public benefits on or after that date.” Whether the rule applies to a particular person is a question for an immigration lawyer or a DOJ-accredited representative, and a letter from a state agency about coverage or immigration status is best reviewed with such assistance before a reply is sent. Free and low-cost legal services are listed on the map of legal services.

The federal parity law (MHPAEA) generally prohibits group health plans and health insurance issuers from applying financial requirements or treatment limitations to mental health and substance use disorder benefits that are more restrictive than those applied to medical and surgical benefits. According to CMS, the 2024 rule requires plans and issuers “to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits.”

In a statement of 15 May 2025, the Departments of Labor, Health and Human Services and the Treasury stated: “The Departments will not enforce the 2024 Final Rule or otherwise pursue enforcement actions, based on a failure to comply that occurs prior to a final decision in the litigation, plus an additional 18 months. This enforcement relief applies only with respect to those portions of the 2024 Final Rule that are new in relation to the 2013 final rule.” The same statement provides that “MHPAEA’s statutory obligations, as amended by the CAA, 2021, continue to have effect.” The 2026 regulatory agenda lists a proposed rule that “would propose requirements under the Mental Health Parity and Addiction Equity Act (MHPAEA) to clarify plans’ and issuers’ obligations, promote compliance, and reduce burden,” planned for November or December 2026; as of 28 September 2026 it had not been published.

A plan member may request in writing the medical necessity criteria the plan used, the reason for a denial, and the plan’s comparative analysis of the limits it applies to mental health and medical benefits. For coverage through an employer, the Employee Benefits Security Administration answers questions at 1-866-444-3272; for other coverage, the state insurance department answers them. Copies of plan correspondence and the dates of each request support an appeal. Free and low-cost legal services are listed on the map of legal services.

Health care interpreting is provided in person, by telephone or by video remote interpreting. In-person interpreting is generally preferred for difficult, emotional or mental health visits, and HRSA’s guidance describes it as “an industry best practice.” The Section 1557 rule requires a covered entity to “offer a qualified interpreter” (45 CFR 92.201) and requires review of machine translation by a qualified human translator “when accuracy is essential.” A nationally certified medical interpreter (CMI or CHI) has passed a formal examination. CLAS Standard 7 states that “the use of untrained individuals and/or minors as interpreters should be avoided.” Tone and idiom are particularly important in mental health care, where they can affect assessment and diagnosis.

An interpreter may be requested at any point, and under the Section 1557 rule language assistance in covered programs is free of charge. When an appointment is scheduled, the language and dialect can be stated and a professional interpreter requested, with a note in the medical record for later visits. HHS states in its fact sheet: “You are not required to bring your own interpreter, pay for an interpreter, or rely on a child or family member to interpret for you.” For a mental health visit, an in-person interpreter and, where possible, the same interpreter at each visit may be requested. For a telehealth appointment, the clinic can be asked in advance to arrange an interpreter. Section 6213 of the Consolidated Appropriations Act, 2026 requires HHS to issue guidance on “[b]est practices on facilitating and integrating use of interpreters during a telemedicine appointment” by 3 February 2027; as of 28 September 2026 this guidance had not been issued.

If a federally funded provider refuses an interpreter, charges for one, relies on a child to interpret, or provides worse care because of language, a civil rights complaint may be filed with the HHS Office for Civil Rights. According to the HHS complaint process, a complaint must “[b]e filed within 180 days of when you knew that the act or omission complained of occurred,” and “OCR may extend the 180-day period if you can show ‘good cause.’” A lawyer is not required. The complaint form lists “National Origin (including ancestry, ethnicity, and language)” as a basis for a complaint and does not ask about immigration status. The office’s toll-free number is 1-800-368-1019 (TDD 1-800-537-7697). A hospital’s Section 1557 coordinator or grievance process, and legal aid or immigrant rights organizations, can also assist. Notes of dates, names and events support a complaint.

In March 2025 the Justice Department rescinded its 2002 guidance on limited English proficiency, and Executive Order 14224 revoked Executive Order 13166. lep.gov was suspended in July 2025, and the new guidance that the Attorney General’s memorandum promised “[w]ithin 180 days” had not been published as of 28 September 2026. Beginning in December 2025, federal agencies repealed the disparate-impact provisions of their Title VI regulations; the HHS rule took effect on 24 July 2026, and 45 CFR 80.3(b)(2) now reads “[Reserved].”

The language requirements of the 2024 Section 1557 rule remain in the regulations: the notice of availability at 45 CFR 92.11 and the qualified interpreter requirement at 45 CFR 92.201. The provisions vacated in October 2025, listed in the HHS notice of 2 June 2026, concern gender identity, and the notice states that “[t]he other provisions of the Section 1557 Rule remain in force.” For 2027 coverage, CMS removed its separate multilingual notice for Medicare Advantage and Part D plans, stating that “CMS is finalizing the rescission of CMS’s NoA requirements ... as proposed” (NoA: Notice of Availability); plans must still offer free interpreter services on their call lines and translate required materials into any language spoken by at least 5 percent of people in the plan’s service area.

Three actions are pending. HHS lists a proposed Section 1557 rule with a target date of February 2027, intended in part to “reduce unnecessary burdens,” without identifying the provisions that would change. The agencies list a new parity proposal for late 2026, while the new requirements of the 2024 parity rule have gone unenforced since May 2025. Section 6213 of the Consolidated Appropriations Act, 2026 requires HHS to issue guidance on language access in telehealth, including “[b]est practices on facilitating and integrating use of interpreters during a telemedicine appointment,” by 3 February 2027. The sections above describe how services are requested and where complaints are filed. Free and low-cost legal services are listed on the map of legal services.