Executive Order 13166

With a quick stroke of his pen, then President William J. Clinton signed Executive Order 13166 into law on August 11, 2000. With that act, the federal government became officially multilingual, requiring any entity receiving federal monies to provide services in any language. Private physicians, clinics, and hospitals that accept Medicare and Medicaid must provide, at their own expense, translators for any language spoken by any patient.

In a report to Congress in 2002, the U.S. Office of Management and Budget (OMB) reported that forcing physicians to provide multilingual outpatient services would cost $180.8 million annually. In addition, inpatient services in multiple languages would cost hospitals $78.2 million, while the bill for multilingual emergency room services would tally $8.6 million, pushing the health care total to $267.6 million.

Concerned by the enormous and burdensome costs involved, the American Medical Association (AMA) has spoken out against the Order. In a letter to OMB, the AMA reported that the cost of an interpreter can exceed the reimbursement of a Medicare or Medicaid visit by 13 times – costing doctors more than $500 per translator (based on figures from the Centers for Medicare and Medicaid Services – Medicare reimburses doctors roughly $40, which is 80 percent of the average national payment rate of $50 and approximately $35 for Medicaid patients).

A prescription for failure for our nation’s physicians, U.S.ENGLISH believes our nation’s medical providers should practice medicine, not new languages.

Following is a full copy of the Order signed by Mr. Clinton:


By the authority vested in me as President by the Constitution and the laws of the United States of America, and to improve access to federally conducted and federally assisted programs and activities for persons who, as a result of national origin, are limited in their English proficiency (LEP), it is hereby ordered as follows:

Section 1. Goals.
The Federal Government provides and funds an array of services that can be made accessible to otherwise eligible persons who are not proficient in the English language. The Federal Government is committed to improving the accessibility of these services to eligible LEP persons, a goal that reinforces its equally important commitment to promoting programs and activities designed to help individuals learn English. To this end, each Federal agency shall examine the services it provides and develop and implement a system by which LEP persons can meaningfully access those services consistent with, and without unduly burdening, the fundamental mission of the agency. Each Federal agency shall also work to ensure that recipients of Federal financial assistance (recipients) provide meaningful access to their LEP applicants and beneficiaries. To assist the agencies with this endeavor, the Department of Justice has today issued a general guidance document (LEP Guidance), which sets forth the compliance standards that recipients must follow to ensure that the programs and activities they normally provide in English are accessible to LEP persons and thus do not discriminate on the basis of national origin in violation of title VI of the Civil Rights Act of 1964, as amended, and its implementing regulations. As described in the LEP Guidance, recipients must take reasonable steps to ensure meaningful access to their programs and activities by LEP persons.

Section 2. Federally Conducted Programs and Activities.
Each Federal agency shall prepare a plan to improve access to its federally conducted programs and activities by eligible LEP persons. Each plan shall be consistent with the standards set forth in the LEP Guidance, and shall include the steps the agency will take to ensure that eligible LEP persons can meaningfully access the agency’s programs and activities. Agencies shall develop and begin to implement these plans within 120 days of the date of this order, and shall send copies of their plans to the Department of Justice, which shall serve as the central repository of the agencies’ plans.

Section 3. Federally Assisted Programs and Activities.
Each agency providing Federal financial assistance shall draft title VI guidance specifically tailored to its recipients that is consistent with the LEP Guidance issued by the Department of Justice. This agency-specific guidance shall detail how the general standards established in the LEP Guidance will be applied to the agency’s recipients. The agency-specific guidance shall take into account the types of services provided by the recipients, the individuals served by the recipients, and other factors set out in the LEP Guidance. Agencies that already have developed title VI guidance that the Department of Justice determines is consistent with the LEP Guidance shall examine their existing guidance, as well as their programs and activities, to determine if additional guidance is necessary to comply with this order. The Department of Justice shall consult with the agencies in creating their guidance and, within 120 days of the date of this order, each agency shall submit its specific guidance to the Department of Justice for review and approval. Following approval by the Department of Justice, each agency shall publish its guidance document in the Federal Register for public comment.

Section 4. Consultations.
In carrying out this order, agencies shall ensure that stakeholders, such as LEP persons and their representative organizations, recipients, and other appropriate individuals or entities, have an adequate opportunity to provide input. Agencies will evaluate the particular needs of the LEP persons they and their recipients serve and the burdens of compliance on the agency and its recipients. This input from stakeholders will assist the agencies in developing an approach to ensuring meaningful access by LEP persons that is practical and effective, fiscally responsible, responsive to the particular circumstances of each agency, and can be readily implemented.

Sec. 5. Judicial Review.
This order is intended only to improve the internal management of the executive branch and does not create any right or benefit, substantive or procedural, enforceable at law or equity by a party against the United States, its agencies, its officers or employees, or any person.