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The Impact of Threshold Language Assistance Programming on the Accessibility of Mental Health Services for Persons With Limited English Proficiency in the Medi-Cal Setting

McClellan, Sean R. BA*; Wu, Frances M. BS, MS*; Snowden, Lonnie R. PhD

doi: 10.1097/MLR.0b013e3182463432
Brief Report

Background: Title VI of the 1964 Civil Rights Act prohibits federal funds recipients from providing care to limited English proficiency (LEP) persons more limited in scope or lower in quality than care provided to others. In 1999, the California Department of Mental Health implemented a “threshold language access policy” to meet its Title VI obligations. Under this policy, Medi-Cal agencies must provide language assistance programming in a non-English language where a county’s Medical population contains either 3000 residents or 5% speakers of that language.

Research Design: We examine the impact of threshold language policy-required language assistance programming on LEP persons’ access to mental health services by analyzing the county-level penetration rate of services for Russian, Spanish, and Vietnamese speakers across 34 California counties, over 10 years of quarterly data. Exploiting a time series with nonequivalent control group study design, we studied this phenomena using linear regression with random county effects to account for trends over time.

Results: Threshold language policy-required assistance programming led to an immediate and significant increase in the penetration rate of mental health services for Russian (8.2, P < 0.01) and Vietnamese (3.3, P < 0.01) language speaking persons.

Conclusions: Threshold language assistance programming was effective in increasing mental health access for Russian and Vietnamese, but not for Spanish-speaking LEP persons.

*Health Services and Policy Analysis program, University of California

School of Public Health, University of California, UC Berkeley, Berkeley, CA

Funding Received: National Institute of Mental Health Grant# R01 MH070942.

The authors declare no conflict of interest.

Reprints: Lonnie R. Snowden, PhD, 235 University Hall, School of Public Health, University of California, UC Berkeley, Berkeley, CA 94720-7360. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.