According to the 2011 American Community Survey conducted by the Census Bureau, in the United States, 60 million people (1 in 5 Americans) speak a language other than English in their home. Out of that 20% of the population, 9% are considered to be Limited English Proficient (LEP).

Presidential Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, directs recipients of federal funds to “examine the services it provides and develop and implement a system by which LEP persons can meaningfully access those services consistent with, and without unduly burdening, the fundamental mission of the [recipient].”

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). Section 6 of Title VI of the Civil Rights Act of 1964 provides that “no person in the United States shall, on the ground of race, color or national origin be excluded from participation in, be denied the benefits of or be subjected to discrimination under any program or activity receiving Federal financial assistance.”