The Centers for Medicare and Medicaid Services (CMS) has updated the requirements on group health plans and health insurance issuers to ensure cultural and linguistic access in the implementation of the Affordable Care Act (ACA). Section 2719 of the Public Health Services Act requires non-grandfathered group health plans and health insurance issuers to provide relevant notices in a culturally and linguistically appropriate manner. The regulations implementing section 2719 require these plans and issuers to provide translated notices sent to an address in a county meeting a threshold percentage of people who are literate only in the same non-English language. This threshold percentage is set at 10 percent or more of the population residing in the insured individual’s county, based on American Community Survey data. Moreover, section 2715 of the Public Health Services Act requires group health plans and health insurance issuers to provide the summary of benefits and coverage and uniform glossary in a culturally and linguistically appropriate manner. The regulations implementing section 2715 adopt the same ten percent threshold in the section 2719 implementing regulations. The updated CMS list identifies the counties which meet or exceed the 10 percent threshold, based on 2010-2014 American Community Survey data.
While dozens of counties exceed the 10 percent threshold for Spanish, only San Francisco County in California meets the threshold for Chinese, Aleutians East Borough and Aleutians West Census Area in Alaska for Tagalog, and Apache County in Arizona for Navajo. Language access advocates have argued that the 10 percent threshold is too high (and should be 5 percent, or other numerical thresholds) and that health plans and health insurance issuers should be accountable for these language access requirements in many more counties.