Addressing language barriers in U.S. healthcare: The role of clas standards, telehealth, and policy in supporting limited english proficiency populations

The United States is home to 29.6 million individuals with limited English proficiency (LEP), a population facing persistent healthcare disparities despite legal protections under Title VI of the Civil Rights Act and the Affordable Care Act. LEP individuals experience higher uninsured rates, lower use of preventive care, and poorer health outcomes than their English-proficient counterparts. These disparities are compounded by broader social drivers of health, such as income, education, housing, and digital access, which influence communication and care navigation. Systemic deficiencies in language access policies, including inconsistent implementation of Culturally and Linguistically Appropriate Services (CLAS) standards and limited provider training, further exacerbate inequities. The COVID-19 pandemic intensified these challenges but also catalyzed the adoption of telehealth and remote interpretation, which improved access in some areas while introducing new barriers, including technological limitations and disparities in digital literacy. Only 13% of hospitals meet all CLAS language-related benchmarks due to interpreter shortages, insufficient multilingual materials, and inadequate reimbursement. The unwinding of the Medicaid Continuous Enrollment Provision has also increased the risk of coverage loss for LEP beneficiaries, especially when re-enrollment processes are not language accessible. This narrative review examines barriers to implementing effective language services, the operational and policy implications of these gaps, and the role of telehealth, AI-based tools, and community partnerships in advancing equity. Strengthening provider training, health system infrastructure, and policy frameworks is essential to improving culturally and linguistically appropriate care for diverse populations.