What Does Section 1557 Require Hospitals to Provide for Patients with Limited English Proficiency?

By Jenny Esno, SVP, Commercial ·

Published October 26, 2026 · Updated October 26, 2026

Section 1557 language access rules did not go away in 2025. Executive Order 14224 made English the official language of the United States and shifted federal agency priorities, but it did not repeal Section 1557 or the 2024 final rule that implements it. For hospitals, the obligations below are still the working standard in October 2026.

The patient population is large. KFF estimates more than 27.3 million people in the U.S. ages 5 and older have limited English proficiency, based on 2023 American Community Survey data. In a KFF survey published May 16, 2024, about half of adults with limited English proficiency reported at least one language barrier in health care over the prior three years, and 30% had trouble understanding a provider's instructions.

This post is general information, not legal advice. Hospitals should confirm their specific obligations with counsel.

Which hospitals have to comply with Section 1557 language access rules?

Section 1557 applies to any health program or activity that receives federal financial assistance from the U.S. Department of Health and Human Services (HHS). That includes virtually every hospital that participates in Medicare or Medicaid. Under the 2024 final rule, Medicare Part B payments also count as federal financial assistance, which brings many physician practices into scope.

Coverage extends to the whole organization, not just one department. If a health system receives federal funds, Section 1557 language access requirements apply across its hospitals, clinics, patient portals, billing offices, and call centers. Health insurance issuers and HHS-run programs are also covered.

What counts as a "qualified interpreter" under Section 1557?

A qualified interpreter under Section 1557 is someone who has demonstrated proficiency in English and at least one other language; follows interpreter ethics including confidentiality; and can interpret effectively, accurately, and impartially using medical terminology. Being bilingual is not enough. A hospital must be able to show the interpreter meets that standard.

That definition rules out the most common shortcuts. A bilingual nurse, registrar, or security guard is not automatically a qualified interpreter under Section 1557. Hospitals that rely on bilingual employees should assess and document each employee's interpreting skill, or route those encounters to professional interpreters through phone (OPI), video (VRI), or on-site interpreting.

Can hospitals use family members or children as interpreters?

Hospitals generally cannot rely on family members, friends, or children to interpret under Section 1557. A minor child may interpret only in an emergency involving an imminent threat to someone's safety when no qualified interpreter is immediately available. An accompanying adult may interpret only in that emergency, or when the patient specifically asks and the adult agrees.

Even when a patient requests a family member, the hospital's Section 1557 obligation does not disappear. Best practice is to document the request; offer a professional interpreter at no cost anyway; and bring in a qualified interpreter for anything involving diagnosis, consent, medications, or discharge. Hospitals also cannot require a patient to bring their own interpreter.

Is machine translation allowed under Section 1557?

Machine translation is allowed under Section 1557, but with a guardrail. When a translated document is critical to a patient's rights, benefits, or meaningful access; when accuracy is essential; or when the text contains complex or technical language, a qualified human translator must review the machine output before the hospital relies on it.

In a hospital, that review requirement covers most of the documents that matter: consent forms, discharge instructions, medication instructions, financial assistance applications, and billing notices. Machine translation can speed up the first draft of a translated document. Machine translation cannot be the final step for critical patient materials under Section 1557.

What is the Section 1557 notice of availability?

The Section 1557 notice of availability tells patients that free language assistance is available and how to get it. Hospitals must post the notice in English and in at least the 15 languages most commonly spoken by people with limited English proficiency in the relevant state or states — on the website, in physical locations, and with key documents.

The notice of availability has to accompany specific patient communications including applications, consent forms, discharge papers, notices of privacy practices, and billing or collections materials. Hospitals must also provide the notice at least annually. Multistate health systems should aggregate the top-15 language lists for every state they operate in.

What policies, procedures, and training does Section 1557 require?

Section 1557 requires covered hospitals to adopt written language access procedures, designate a Section 1557 coordinator if they have 15 or more employees, and train relevant staff on those procedures. The written procedures should explain how staff identify a patient's language, reach a qualified interpreter, and get documents translated.

Training is where many hospitals fall short. Front-desk staff, nurses, and physicians all need to know how to connect an interpreter in under a minute, when a bilingual colleague is and is not an option, and how to document interpreter use. Section 1557 training should be refreshed when procedures change and built into onboarding for new hires.

Section 1557 language access checklist for hospitals

Did Executive Order 14224 change Section 1557 requirements?

Executive Order 14224 did not change Section 1557 requirements for hospitals. The March 2025 order designated English as the official language and directed federal agencies to revisit their own multilingual services, but an executive order cannot repeal a statute. The 2024 Section 1557 final rule remains in effect for covered hospitals.

Federal enforcement priorities did shift. In April 2025, the U.S. Department of Justice rescinded its 2022 language access guidance and took down the LEP.gov resource site, according to a KFF analysis published October 10, 2025. A hospital's Section 1557 exposure still includes private lawsuits, state civil rights laws, accreditation surveys, and patient-safety liability.

What do hospitals get wrong about Section 1557 compliance?

The most common Section 1557 mistake is treating bilingual staff as qualified interpreters without testing them. Other frequent gaps: letting family members interpret routine visits, sending machine-translated discharge instructions without human review, posting an outdated language list, and assuming Executive Order 14224 ended the obligation.

Those gaps carry clinical risk, not just legal risk. A study of pediatric emergency encounters published in Annals of Emergency Medicine in November 2012 found that 22% of errors made by ad hoc interpreters had potential clinical consequences, compared with 12% for professional interpreters — and 2% for professional interpreters with at least 100 hours of training.

Five Section 1557 compliance gaps to audit this quarter:

1. Untested bilingual staff. Employees interpret without any documented language assessment.
2. Family interpreting by default. Companions interpret because it is faster, not because the patient asked.
3. Unreviewed machine translation. Critical documents go out without a qualified human translator's review.
4. Stale notices. The top-15 language list has not been checked against current state data.
5. No usage data. The hospital cannot show how often interpreters were offered, used, or declined.

Frequently asked questions

Does Section 1557 apply to small physician practices? Section 1557 applies to physician practices that receive federal financial assistance, and the 2024 final rule counts Medicare Part B payments as federal financial assistance. Most practices that bill Medicare are therefore covered. Practices with fewer than 15 employees are exempt from some administrative requirements, such as designating a Section 1557 coordinator, but still must provide language access.

Can a patient refuse a professional interpreter? Yes. A patient with limited English proficiency can decline a professional interpreter and ask an accompanying adult to interpret instead. The hospital should document the refusal, confirm the adult agrees, and consider whether relying on that adult is appropriate. For high-stakes conversations, many hospitals keep a professional interpreter on the line to monitor accuracy.

Who pays for interpreters under Section 1557? The hospital pays. Section 1557 requires language assistance services to be provided free of charge to the patient. Hospitals cannot bill patients for interpreters or translated documents, cannot require patients to bring their own interpreters, and cannot delay care in a way that penalizes patients for needing language assistance.

Do state laws add requirements beyond Section 1557? Many states add language access requirements beyond Section 1557, such as interpreter certification standards, translated-document mandates, or hospital licensing rules. Section 1557 sets the federal floor. Hospitals operating in states like California, New York, and Washington should map state rules alongside federal requirements when writing language access procedures.

Check your Section 1557 readiness

Not sure where your organization stands? GLOBO's language access team can review your interpreter workflows, translated documents, and notice of availability against the Section 1557 checklist. Let us and show you where the gaps are. Request a language access assessment →

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