1. Why did New York codify federal healthcare language protections into state law? To ensure language access protections remain durable and enforceable at the state level regardless of potential changes or weakening of federal Section 1557 regulations.
2. What is the "one percent threshold" requirement in New York’s new law? Hospitals must translate essential documents for any language group representing at least one percent of their service area population based on annual needs assessments.
3. How does robust language access impact hospital performance and patient outcomes? It improves patient safety, reduces medical errors and readmission rates, and increases HCAHPS scores by ensuring patients fully understand their clinical care and instructions.
New York recently became the first state to essentially write federal healthcare language protections into its own law, and the timing couldn’t be more significant.
Governor Kathy Hochul signed Senate Bill S6288B, requiring every general hospital in New York to establish comprehensive language assistance programs. But this isn’t just a New York story. The legislation arrives at a moment when federal language access protections face an uncertain future, and it offers other states a detailed blueprint for safeguarding patients with limited English proficiency regardless of what happens in Washington D.C.
Section 1557 of the Affordable Care Act is a federal law that prohibits discrimination and mandates language assistance in healthcare programs receiving federal funding. New York’s law matters because it translates those federal expectations into durable state statute at a moment of uncertainty.
Specifically, the law:
Section 1557 remains in effect, and healthcare organizations receiving federal funding must continue to comply with it. But New York has now ensured that even if federal policy shifts, hospitals in the state will maintain robust language access standards.
For states with large multilingual populations, this framework demonstrates what comprehensive language access looks like when long-standing expectations are clearly defined, enforceable, and durable.
“This legislation builds on New York’s role as a national leader in breaking down barriers to quality health care,” Governor Hochul said at the signing. New York's leadership could prove even more consequential if other states follow suit.
Before diving into the operational details, it is worth clarifying a point that has caused confusion since the bill was signed. The law does not create new requirements for hospitals. Instead, it elevates existing regulatory obligations—expectations hospitals have been required to meet for years—into state statute, giving them permanence and enforceability.
This clarification matters, particularly given how the bill evolved. Earlier versions would have imposed significantly more burdensome new requirements. When the legislation reached the health committee, the committee chair asked stakeholders what version hospitals could realistically support. The chair’s office ultimately proposed aligning the bill with existing regulatory requirements, elevating long-standing expectations into statute and giving them the permanence and enforceability that only state law provides.
At a high level, the law requires hospitals to formalize and consistently execute language access practices they were already expected to have in place.
New York's leadership could prove even more consequential if other states follow suit."
The law establishes clear, operational building blocks:
Documentation requirements matter too. Hospitals must record each patient’s preferred language in their medical record and note whether they accepted or declined language assistance. The law also strongly restricts using family members or friends as interpreters unless the patient explicitly consents, professional services have been offered and refused, and the hospital addresses concerns about competency and conflicts of interest.
One provision goes beyond current federal requirements: hospitals must conduct annual needs assessments using census data, administrative records, and school enrollment information to identify language groups representing more than one percent of their service area population.
They must then translate essential forms, discharge instructions, consent documents, and other significant materials into those languages. This “one percent threshold” ensures that even smaller language communities receive meaningful access to critical health information in writing, not just through interpreters.
For rural hospitals that may struggle with immediate implementation, the law provides flexibility: they can apply for reasonable timelines if they demonstrate good-faith compliance efforts and implement effective interim plans.
New York’s diverse population makes this law immediately consequential. Millions of state residents and visitors speak Spanish, Chinese, Russian, Bengali, Korean, and dozens of other languages. Communication barriers in healthcare settings have led to misunderstood diagnoses, medication errors, confusion about discharge instructions, and patients who simply avoid seeking care because the process is too difficult to navigate.
Beyond patient safety, language barriers carry measurable costs:
Effective language assistance programs improve Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, reduce medical errors, and increase treatment adherence. When patients fully understand their care, everyone benefits.
For healthcare organizations outside New York, this law functions as both a model and a prompt for self-assessment.
What makes New York’s law potentially transformative is its specificity and durability—not because it raises the bar, but because it locks in standards hospitals already follow. Language access coordinators across the country often struggle with questions like:
New York provides answers. The annual needs assessment with a one percent threshold gives organizations a clear methodology. The coordinator requirement establishes accountability. The documentation standards create consistency. The restrictions on using family as interpreters protect vulnerable patients. These aren’t theoretical ideals. They’re concrete, implementable requirements that other states can adopt or adapt.
Section 1557 remains in effect federally, and compliance remains mandatory for healthcare organizations receiving federal funding. But New York has demonstrated that states can solidify existing expectations into law, ensuring language access protections persist regardless of federal policy shifts.
If your organization is assessing its current language access program or preparing for potential state-level mandates, now is the time to act. Contact LanguageLine to schedule a free consultation and explore how we can help you align with best practices and emerging standards.
Download free, state-specific Section 1557 “Notice of Availability” posters — plus our Section 1557 checklist and other compliance tools — from LanguageLine’s Section 1557 Compliance Hub.