Lack of medical interpretation puts California’s most vulnerable at risk

The UC Berkeley Center for Health Management and Policy Research (CHAMP), a center of the UC Berkeley School of Public Health, has released two reports detailing the current state of medical interpretation and language access in California’s primary care safety net.

Together, these evaluations provide a comprehensive look at how professional medical interpretation improves clinical outcomes and the systemic challenges that remain for the millions of Californians with limited English proficiency.

“Our research reveals structural inequities in our payment system, related to the provision of interpreter services and promotion of a multilingual physician and clinician workforce,” said Dr. Hector Rodriguez, professor of health policy and management and co-director of CHAMP, who led the projects.

“The clinic organizations serving our lowest-income populations report that managed care plan services they are getting through the state’s Medicaid program for low-income populations are not sufficiently responsive to local needs. As a result, they have to spend their own philanthropy and operation dollars to support and augment language services through private contracts.”

The first report, commissioned and funded by the California Department of Health Care Services, assesses the impact of the Medical Interpreter Pilot Project (MIPP), which embedded culturally competent, professional medical interpreters for Medi-Cal members in three community health centers in Contra Costa, Los Angeles, and San Diego counties.

The MIPP report found that professional interpretation significantly enhanced the quality of care at the three clinics by facilitating stronger patient-clinician relationships, better patient understanding of treatment plans, and improved medication adherence. The pilot was also associated with measurable improvements in clinical quality indicators, including increased rates of cervical and colorectal cancer screening, tobacco screening, and follow-up for obesity and depression.

Medi-Cal members expressed high levels of satisfaction, noting that professional interpreters helped them better understand medication instructions and feel more comfortable disclosing details about their condition. Clinicians also reported strong satisfaction, noting that having dedicated professional interpreters strengthened patient trust and reduced burden on multilingual medical assistants, thereby streamlining clinic workflows.

The evaluation analyzed data collected over a 24-month period (October 2022–September 2024) across three pilot community health center organizations. During this time, MIPP supported 8,702 clinical encounters for 4,126 unique Medi-Cal members with LEP, delivering more than 320,000 minutes of professional medical interpretation across 31 languages and 23 clinical service areas, including primary care, dental care, obstetrics/gynecology, and health education.

Complementing the MIPP evaluation, CHAMP also conducted the 2025 California Primary Care Language Access Survey, funded by the California Health Care Foundation. This report is the first statewide assessment of language access infrastructure across 101 safety-net clinics and includes interviews with 14 clinic leaders.

The survey illuminates a significant disconnect between high linguistic needs and available resources. Many clinics described Medi-Cal Managed Care Plan language lines as being nominally available, but functionally inaccessible due to long wait times and administrative hurdles. As a result, 54% of clinics privately contract interpretation vendors to fill these gaps, primarily using reserve funding. In the absence of professional medical interpreters, 58% of clinics rely on multilingual non-clinical staff for interpretation, yet 85% of these clinics lack the resources to provide formal medical interpreter training for them.

Strikingly, there is limited formal monitoring or enforcement for the quality of interpreter services or responsiveness.

The survey also revealed that speakers of Indigenous languages face the most severe access gaps, often relying on family members and friends for interpretation out of necessity.

However, this project also revealed several bright spots in workforce innovation, as over half of the surveyed clinics report that the majority of their clinicians and staff are multilingual. Innovative programs to build a stronger multilingual clinical workforce, such as in-house healthcare mentorship pipelines and the Licensed Physicians from Mexico Pilot Program, help clinics bridge language gaps directly through language-appropriate care.

The multi-role interpreter model demonstrates a financially sustainable pathway for in-house language access by transforming the interpreter from a narrow, encounter-specific service to an integrated care team member who supports the whole patient experience.

The authors also note that efforts to use AI for translation services and related assistance should be developed in a culturally competent way and incorporate key stakeholder input when training AI translation applications, picking up nuances between subgroups, for example, Spanish-language slang and phrases used by Mexican Americans compared to Puerto Ricans.

They also stress that professional interpreters do more than simply interpret and translate. They serve as cultural liaisons who help patients navigate the health care system.

The reports offer several recommendations for the future, including strengthening accountability for Medi-Cal Managed Care Plans, increasing the number of multilingual clinicians, and providing targeted training resources for multilingual clinic staff.