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Title page 1

Contents 8

Acknowledgements 10

EXECUTIVE SUMMARY 12

CHAPTER 1: Introduction and Overview 26

Defining Limited English Proficient 30

The Limited English Proficient Population in the United States 34

Language Access in Social Safety Net Programs 41

Eligibility for Benefits 42

Language Barriers in Social Safety Net Programs 44

Language Barriers in Health Care 51

Accessibility of Language Services in Hospitals 56

Common Challenges for Language Access in Social Safety Net Programs and Health Care 57

Lack of Data 57

Insufficient Use of Language Services 59

Languages of Lesser Diffusion 63

Technology 65

Ad Hoc Interpreters 67

Successes in Language Access Programs 70

CHAPTER 2: Legal Landscape and Federal Government Response 76

Title VI of the Civil Rights Act of 1964 76

Lau v. Nichols (1974) 77

E.O. 13166 (2000) 79

E.O. 14224 (2025) 83

Federal Legislation Beyond Title VI 87

State and Local Regulations 91

CHAPTER 3: Language Access in Federally Funded Programs 94

Language Access in SNAP (USDA) 94

SNAP Eligibility 96

USDA Language Access Regulations and Guidance 98

USDA Oversight of State SNAP Agencies 106

Language Access in Hospitals (HHS) 113

Historical HHS Title VI Guidance 114

The Affordable Care Act (ACA) Section 1557 Implementing Regulations 116

HHS Oversight of Language Access in Hospitals 120

CHAPTER 4: Website Content Analysis & Community Organization Survey 124

Research Approach 125

Sample 125

LEP Language Data and Method 128

Language Access Measures 131

Quantitative Results 132

State SNAP Websites 132

County Websites 138

Hospitals 143

Qualitative Data from Organizations: Sample, Recruitment, and Analysis 150

Qualitative Results 151

The Far Reach of Limited English Proficiency 151

Differences in Access by Language 154

The Role of Technology 157

Related Barriers to Access 158

The Current State of Language Access 160

Success in Language Access 160

CHAPTER 5: Findings and Recommendations 164

APPENDIX A: Sampling Method and Data 174

Sampling Technique 174

County and Hospital Samples 176

Community Organizations Sample 177

APPENDIX B: 2025 Language Access LEP Organization Survey 194

Statement of Chair Rochelle M. Garza 200

Statement of Commissioner Stephen Gilchrist 204

Statement of Commissioner Glenn D. Magpantay 208

Tables 32

Table 1.1. American Community Survey Responses to English Ability Question by Language Group 32

Table 1.2. LEP Population by Language Spoken at Home among Individuals 5 Years Old and Above 35

Table 3.1. Food and Nutrition Service State SNAP Language Access Study Results 109

Table 4.1. Descriptive Statistics of Selected Counties 126

Table 4.2. Number of Sample Counties for Which Each Language is in the Top Three Most Common Among the LEP Population 128

Table 4.3. Percentage of Top Languages Spoken in Sample Counties 130

Table 4.4. Characteristics of State SNAP Websites 133

Table 4.5. Characteristics of County Websites 139

Table 4.6. County Website Translation Tool by Urbanicity 141

Table 4.7. County Website Translation Tool by LEP Category 142

Table 4.8. County Website Resources by Urbanicity 142

Table 4.9. County Website Resources by LEP Category 143

Table 4.10. Characteristics of Hospital Websites 144

Table 4.11. Hospital Website Translation Tool by County Urbanicity 148

Table 4.12. Hospital Website Translation Tool by County LEP Category 148

Table 4.13. Hospital Website Resources by County Urbanicity 149

Table 4.14. Hospital Website Resources by County LEP Category 149

Figures 31

Figure 1.1. Census Bureau Question Measuring English Proficiency 31

Figure 1.2. LEP Population across the United States 37

Figure 1.3. U.S. Immigrant Population by Region of Birth, 1960-2023 39

Figure 1.4. Trends in Foreign Language Speakers and Limited English Proficiency in the U.S., 1980-2023 41

Figure 1.5. Language Barriers to Health Care Access 54

Figure 1.6. Service Areas of U.S. Hospitals With and Without Language Services by Level of Need, 2013 57

Figure 3.1. USDA "I Speak" Cards 105

Figure 4.1. Example of a Website Dropdown Menu, Oregon 132

Figure 4.2. Example of a Website Translation Button, North Carolina 133

Figure 4.3. Example of a Website Translation Button to Machine Translation, Georgia 135

Figure 4.4. Example of a Website Language Resource, Florida 136

Figure 4.5. Embedded Language Access Resources on State SNAP Websites by Top Three LEP Languages in Sampled Counties 137

Figure 4.6. Language Translations on State SNAP Websites by Top Three LEP Languages in Sampled Counties 138

Figure 4.7. Embedded Language Access Resources on County Websites by Top Three LEP Languages 140

Figure 4.8. Language Translations on County Websites by Top Three LEP Languages in Sampled Counties 141

Figure 4.9. Embedded Language Access Resources on Hospital Websites by Top Three LEP Languages 146

Figure 4.10. Language Translations on Hospital Websites by Top Three LEP Languages in Sampled Counties 147

Appendix Tables 176

Table A.1. Data Sources for Key Variables in Merged County Dataset 176

Table A.2. Sample County List and Characteristics 178

Table A.3. Summary Statistics of Selected Counties 181

Table A.4. State Sample and State SNAP Website Language Resources 183

Table A.5. Sample Hospitals by County 185

Table A.6. Surveyed Organizations by County 190

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