Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations

Max W. Hadler, Xiao Chen, Erik Gonzalez and Dylan H. Roby


A health policy brief in UCLA Center for Health Policy Research condenses the findings of a study aimed at surveying communication barriers experienced by Limited English Proficiency (“LEP”) patients enrolled in California’s Health Maintenance Organizations (“HMO”).  A significant portion of the HMO population is LEP: approximately one in eight Californian HMO enrollees are LEP. The study found that LEP HMO enrollees experienced significant obstacles to effective communication with staff. Cause for concern is compounded by the observation that LEP enrollees in poorer health are more likely to have difficultly communicating with their doctor.

The study also examined the impact of the 2003 Amendment to the Knox-Knee Health Care Services Act (“KKHCS”) aimed at addressing language access issues. The Amended KKHCS Act requires HMOs to provide enrollees with qualified interpretation and translation services. Notwithstanding this requirement, the study documented that 40 percent of commercial HMO enrollees received language assistance from a non-professional.

The conclusion of the survey was that California’s HMOs should continue to improve their language access services by providing more trained interpreters, and targeting specifically enrollees in poorer health.


The purpose of the health policy brief is to identify the problems faced by Californian Limited English Proficiency enrollees of Health Maintenance Organizations and highlight the policy recommendations for remediating these problems.

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