Section 1557 of the Affordable Care Act: language access and disability nondiscrimination
Section 1557 of the Affordable Care Act prohibits discrimination on the grounds covered by Title VI, Title IX, the Age Discrimination Act, and Section 504 in health programs and activities that receive federal financial assistance, and in programs run by HHS or Title I entities. HHS’s Office for Civil Rights (OCR) enforces it. Its regulation, 45 CFR Part 92, requires covered entities to take reasonable steps to provide meaningful access for people with limited English proficiency and to ensure effective communication with people with disabilities. This page quotes OCR and selected sections of the regulation; it does not reprint the rule.
Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.
Sources read on November 10, 2026: HHS OCR’s Civil Rights Laws, Regulations, and Guidance for Providers of Health Care and Social Services page, and 45 CFR Part 92 on eCFR (up to date as of November 6, 2026; source 89 FR 37692, May 6, 2024). OCR’s own Section 1557 page did not return its content to a scripted read that day, so it is linked, not quoted. As a backup official link, the final rule as published in the Federal Register, Nondiscrimination in Health Programs and Activities (89 FR 37522, May 6, 2024), is linked for reference; eCFR’s source note above cites 89 FR 37692, a page within that same document. The Federal Register copy is not quoted here. This page does not describe litigation about, or the enforcement status of, any provision; check OCR for current information. No penalty amounts are copied.
What Section 1557 covers
OCR’s page describes Section 1557 as providing “that an individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964”, Title IX, the Age Discrimination Act of 1975, or Section 504 of the Rehabilitation Act of 1973, “under any health program or activity, any part of which is receiving Federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments.”
It states: “OCR has enforcement authority with respect to health programs and activities that receive Federal financial assistance from the Department of Health and Human Services (HHS) or are administered by HHS or any entity established under Title I of the Affordable Care Act or its amendments.” The regulation’s purpose section says Section 1557 “prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.”
Under 45 CFR 92.2, the part applies to “Every health program or activity, any part of which receives Federal financial assistance, directly or indirectly, from the Department;” as well as health programs administered by HHS or by a Title I entity. This site does not say whether any clinic, school, or practice is a covered entity.
Language access
45 CFR 92.201 states: “A covered entity must take reasonable steps to provide meaningful access to each individual with limited English proficiency (including companions with limited English proficiency) eligible to be served or likely to be directly affected by its health programs and activities.” It states: “Language assistance services required under paragraph (a) of this section must be provided free of charge, be accurate and timely, and protect the privacy and the independent decision-making ability of the individual with limited English proficiency.”
It also states: “When interpretation services are required under this part, a covered entity must offer a qualified interpreter in its health programs and activities.” On machine translation, it states that when the underlying text is critical to an individual’s rights, benefits, or meaningful access, when accuracy is essential, or when the materials contain complex, non-literal or technical language, “the translation must be reviewed by a qualified human translator.”
Effective communication and disability
45 CFR 92.202 states: “A covered entity must take appropriate steps to ensure that communications with individuals with disabilities (including companions with disabilities), are as effective as communications with non-disabled individuals in its health programs and activities, in accordance with the standards found at 28 CFR 35.130 and 35.160 through 35.164.” It continues: “A covered entity must provide appropriate auxiliary aids and services where necessary to afford individuals with disabilities an equal opportunity to participate in, and enjoy the benefits of, the health program or activity in question. Such auxiliary aids and services must be provided free of charge, in accessible formats, in a timely manner, and in such a way to protect the privacy and the independence of the individual with a disability.”
45 CFR 92.204 states: “A covered entity must ensure that its health programs and activities provided through information and communication technology are accessible to individuals with disabilities, unless doing so would result in undue financial and administrative burdens or a fundamental alteration in the nature of the health programs or activities.” 45 CFR 92.205 states: “A covered entity must make reasonable modifications to policies, practices, or procedures in its health programs and activities when such modifications are necessary to avoid discrimination on the basis of disability, unless the covered entity can demonstrate that making the modifications would fundamentally alter the nature of the health program or activity.”
The ADA’s effective-communication rules for medical offices are on the ADA in therapy settings. Telehealth is covered on telepractice.
What this page does not do
It does not decide whether any provider is a covered entity, it does not reprint the rule or its notice requirements, and it copies no penalty amounts. It is not legal, billing, or compliance advice. Confirm current rules with the agency that publishes them, your employer, and your state board.