By Samoyita Sarkar
Despite the implementation of Language Access Plans (LAPs) across federally qualified health centers (FQHCs) and other healthcare institutions, patients with Limited English Proficiency (LEP) continue to face significant barriers to care. This blog explores the challenges, policy gaps, and potential solutions to ensure equitable healthcare access for LEP populations.
Impact on Patients with Limited English Proficiency (LEP)
With the advent of telehealth, especially during the COVID-19 pandemic, LEP patients faced additional barriers such as difficulties with telephonic interpretation and accessing written translations. Spanish-speaking patients, for example, encountered challenges when contacting schedulers, with roughly 20% of calls being dropped. Many LEP mothers describe the fight to secure healthcare for their children as a “battle,” highlighting the lack of institutional support in navigating the system.
Older adults with LEP are significantly more likely (1.68 – 3.47 times) to experience disparities in oral health and dental care compared to English-speaking adults. Additionally, undocumented immigrants without legal documentation are more likely to miss appointments due to fear stemming from their immigration status. Language barriers also exacerbate disparities in preventive care—LEP patients report lower colorectal cancer screening rates than English-speaking counterparts. Furthermore, LEP patients frequently underutilize digital patient portals, making engagement with emerging healthcare technologies difficult.
Challenges in Implementing Language Access Services
Despite access to professional interpreters and bilingual providers at FQHCs, Spanish-speaking patients often have low comprehension of behavioral health resources. Safety-net hospitals frequently rely on family members, including children, as ad-hoc interpreters, which raises ethical and medical accuracy concerns.
LEP patients also struggle with understanding medical procedures, but video-enhanced consent has been shown to improve comprehension. Discharge instructions and follow-up care present additional challenges due to language barriers. Urban Community Health Centers (CHCs) report increased usage of telehealth interpretation services (TIS), yet confidentiality remains a significant concern.
Policy and Systemic Reforms
To strengthen Language Access Plan (LAP) policies, there must be a shift towards more comprehensive language access approaches at all levels of healthcare delivery. Expansion of interpreter services is critical for equal care for LEP patients, which entails the augmentation of trained medical interpreters at every patient touchpoint. Furthermore, the incorporation of real-time interpretation and bilingual patient education materials into telehealth platforms can improve digital access and communication engagement with patients.
This is a critical piece of outreach that utilizes mobile health clinics and culturally specific programs to help immigrants and refugees gain access to healthcare services. Investment in human resources through hiring bilingual medical staff and training in medical interpretation will improve teamwork and equality in healthcare delivery. Finally, there should be no lapses in the systematic implementation of LAPs throughout all healthcare institutions, so that access to essential services is not obstructed by language barriers.
Intersection of Language Access and Healthcare Outcomes
Language access plays a significant role in healthcare outcomes. For instance, improved colorectal cancer screening rates among LEP patients were linked to a multicultural workforce and enhanced interpreter services. Medicaid and Medicare patients were found to be 20% less likely to receive colorectal cancer screening due to the compounded impact of language and financial barriers.
During the COVID-19 pandemic, CHCs continued their outreach efforts, improving diabetes management among LEP populations through bilingual education campaigns. However, rural CHCs still report persistent disparities in cervical cancer screening rates for LEP women. In response, bilingual educational materials provided by community health workers have proven effective in increasing preventive care engagement.
Looking Ahead: Policy Recommendations for FQHCs
The approaches to language access in the healthcare system must shift to a more comprehensive scope to reinforce LAP policies. An increase in trained medical interpreters at every patient touchpoint is necessary to deliver equitable care to LEP patients. Also, real time interpretation as well as bilingual patient educational materials integrated into telehealth services can enhance digital access and the patients’ participation with these services.
This represents an important aspect of outreach through the use of mobile health clinics and culturally targeted services aimed at assisting immigrants and refugees to access needed healthcare services. Enhancing human resources by appointing bilingual medical staff and training them as interpreters will create better collaboration and equity in service provision. There must also be constant adherence to the comprehensive execution of LAPs for all healthcare institutions so that language barriers do not impede patients’ access to essential services.
To keep offering medical interpretation services, reimbursement expenditures for Medicaid and Medicare need to be adjusted. There is a need for legislative work targeting funding models which will make language services economically and socially viable. Establishing bilingual staff development opportunities through training and tuition reimbursement for language classes as well as certification for medical interpretation services will strengthen the linguistically diverse healthcare workforce.
Mobile health clinics, community health worker outreach, and targeted public health education campaigns are some additional ways to expand programmatic community outreach aimed at addressing the care gap for under-served, limited-English proficient populations. Enhanced telehealth access for patients with LEP requires the integration of real-time interpreter services and multilingual telemedicine interfaces to augment engagement and satisfaction among LEP patients.
Finally, there’s a need to support inclusive health policy development. Collaborating with policymakers and stakeholders to guarantee that language access is included in the social determinants of health and healthcare reform can produce systemic change. Addressing these barriers would enable FQHCs and policymakers to cooperatively achieve a better healthcare system for LEP communities.