Including Language Access into Medicaid ACO Design

UMMS Affiliation

Commonwealth Medicine, Center for Health Law and Economics; Commonwealth Medicine, Center for Health Policy and Research; Department of Family Medicine and Community Health

Publication Date


Document Type



Bioethics and Medical Ethics | Health Policy | Health Services Administration | Health Services Research


Quality health care relies upon communication in a patient's preferred language. Language access in health care occurs when individuals are: (1) Welcomed by providers regardless of language ability; and (2) Offered quality language services as part of their care. Federal law generally requires access to health care and quality language services for deaf and Limited English Proficient (LEP) patients in health care settings, but these patients still find it hard to access health care and quality language services.Meanwhile, several states are implementing Medicaid Accountable Care Organization (ACO) initiatives to reduce health care costs and improve health care quality. Alternative payment methods used in these initiatives can give Accountable Care Organizations more flexibility to design linguistically accessible care, but they can also put ACOs at increased financial risk for the cost of care. If these new payment methods do not account for differences in patient language needs, ACO initiatives could have the unintended consequence of rewarding ACOs who do not reach out to deaf and LEP communities or offer quality language services.We reviewed public documents related to Medicaid ACO initiatives in six states. Some of these documents address language access. More could be done, however, to pay for language access efforts. This article describes Medicaid ACO initiatives and explores how different payment tools could be leveraged to reward ACOs for increased access to care and quality language services. We find that a combination of payment tools might be helpful to encourage both access and quality.


Medicaid, language access, Accountable Care Organization

DOI of Published Version



J Law Med Ethics. 2016 Sep;44(3):492-502. doi: 10.1177/1073110516667945. Link to article on publisher's site

Journal/Book/Conference Title

The Journal of law, medicine and ethics : a journal of the American Society of Law, Medicine and Ethics

Related Resources

Link to Article in PubMed

PubMed ID