CLAS County Data

Edition Date: January 2016

PHS Act section 2719 requires non-grandfathered group health plans and health insurance
issuers offering non-grandfathered health insurance coverage to provide relevant notices in a culturally
and linguistically appropriate manner. The regulations implementing section 2719 require these plans and
issuers to make certain accommodations for notices sent to an address in a county meeting a threshold
percentage of people who are literate only in the same non-English language. This threshold percentage is
set at 10 percent or more of the population residing in the claimants county, as determined based on
American Community Survey (ACS) data published by the United States Census Bureau. 26 C.F.R.
54.9815-2719T, 29 C.F.R. 2590.715-2719, and 45 C.F.R. 147.136.
Section 2715 of the PHS Act requires group health plans and health insurance issuers offering group and
individual coverage to provide the summary of benefits and coverage (SBC) and uniform glossary in a
culturally and linguistically appropriate manner. The regulations implementing section 2715 adopt the ten
percent threshold set forth in the section 2719 implementing regulations. 26 C.F.R. 54.9815-2715, 29
C.F.R. 2590.715-2715, and 45 C.F.R. 147.200. The list below includes all counties which meet or
exceed the 10 percent threshold (rounded to the nearest percent) for the 2010-2014 ACS data and is
applicable until the next edition.1 This list will be updated annually following the release of the applicable
ACS data.2
Relation to Other Language Access and Nondiscrimination Laws
We note that QHP issuers are also responsible for complying with the culturally and linguistically
appropriate standards set forth at 45 CFR 155.205(c) with respect to oral interpretation, written
translations, taglines, and website translations. HHS expects to issue guidance beginning in February
2016 identifying the non-English languages that are triggered by these standards for each State as well as
sample taglines.
In the majority of states, the languages meeting this threshold are also among the top 15 languages spoken
by the LEP populations of that state. However, where a language spoken by at least 10 percent of the
population in the claimants county (such as Navajo) is not among the top 15 languages spoken by the
LEP population of the state, QHP issuers nevertheless must comply with both standards, when applicable.
We also remind QHP issuers of their obligations to provide information in an accessible manner to
individuals with limited English proficiency under federal civil rights laws that also might apply,
including Section 1557 of the Affordable Care Act and Title VI of the Civil Rights Act of 1964 and its
implementing regulation.
Summary of Benefits and Coverage Page Limit
QHP issuers must include an addendum with language taglines in the top 15 languages spoken by the
LEP populations of that state in their summaries of benefits and coverage (SBCs) for QHPs offered
1
The relevant ACS data set is U.S. Census, 2010-2014 American Community Survey 5-Year Estimates, Table
B16001, Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over.
2
The 2010-2014 data was released on December 3, 2015. Assuming the general timing of the release of the data
does not change in future years, CMS anticipates releasing this list in December or the following January of each
year.

through a Marketplace. Any additional taglines required under Public Health Service Act 2715 and its
implementing regulations may also be included in this addendum. The addendum, which must only
include tagline information required by language access standards for critical documents, will not count
towards the four double-sided page limit for the SBC.
Note: Counties may have been added or removed compared to previous years based on changes in the
data.
State

County

Alabama
Alaska

Franklin County
Aleutians East
Borough
Aleutians West
Census Area
Apache County
Santa Cruz County
Yuma County
Sevier County
Colusa County
Fresno County
Glenn County
Imperial County
Kern County
Kings County
Los Angeles County
Madera County
Merced County
Mono County
Monterey County
Napa County
Orange County
Riverside County
San Benito County
San Bernardino
County
San Diego County
San Francisco
County
San Joaquin County
Santa Barbara
County
Santa Cruz County
Stanislaus County

Arizona

Arkansas
California

Chinese
Percentage
---

Navajo
Percentage
---

Spanish
Percentage
10%
11%

Tagalog
Percentage
-22%

--

--

--

12%

---------------------

10%
--------------------

-30%
22%
15%
21%
15%
14%
32%
16%
17%
18%
17%
19%
10%
26%
14%
12%
13%
17%
13%

---------------------

-12%

---

10%
--

---

--

-- ---

12%
16%

---

---

---

12%
13%

---

Colorado

Florida

Georgia

Idaho

Illinois
Iowa
Kansas

Sutter County
Tulare County
Ventura County
Yolo County
Adams County
Costilla County
Eagle County
Morgan County
Phillips County
Saguache County
Collier County
DeSoto County
Hardee County
Hendry County
Miami-Dade County
Okeechobee County
Osceola County
Atkinson County
Echols County
Hall County
Stewart County
Whitfield County
Cassia County
Clark County
Gooding County
Jerome County
Lincoln County
Minidoka County
Power County
Kane County
Buena Vista County
Crawford County
Edwards County
Finney County
Ford County
Grant County
Hamilton County
Haskell County
Seward County
Stanton County
Stevens County

------------------------------------------

-----------------------------------------3

10%
22%
14%
10%
10%
12%
13%
12%
13%
11%
12%
19%
21%
24%
31%
13%
16%
10%
15%
12%
14%
15%
10%
25%
11%
15%
15%
13%
11%
13%
13%
12%
10%
16%
18%
18%
14%
10%
27%
15%
13%

------------------------------------------

Missouri
Nebraska

Nevada
New
Jersey

New
Mexico

New York

North
Carolina
Oklahoma
Oregon
Puerto
Rico

Wyandotte County
Sullivan County
Colfax County
Dakota County
Dawson County
Hall County
Clark County
Cumberland County

---------

---------

10%
10%
24%
14%
16%
10%
10%
10%

---------

Hudson County
Passaic County
Union County
Chaves County

-----

-----

18%
16%
14%
12%

-----

Doa Ana County

Lea County
Luna County
Mora County
San Miguel County
Santa Fe County
Bronx County
New York County
Queens County
Duplin County

-----------

-----------

15%
13%
18%
15%
14%
10%
21%
10%
12%
12%

-----------

Harper County
Texas County
Hood River County
Morrow County
Adjuntas Municipio

------

------

10%
20%
14%
15%
87%

------

Aguada Municipio
Aguadilla Municipio
Aguas Buenas
Municipio
Aibonito Municipio
Aasco Municipio
Arecibo Municipio
Arroyo Municipio
Barceloneta
Municipio
Barranquitas
Municipio

----

----

79%
74%
87%

----

------

------

86%
87%
81%
83%
72%

------

--

--

88%

--

Bayamn Municipio
Cabo Rojo
Municipio
Caguas Municipio
Camuy Municipio
Canvanas
Municipio
Carolina Municipio
Catao Municipio
Cayey Municipio
Ceiba Municipio
Ciales Municipio
Cidra Municipio
Coamo Municipio
Comero Municipio
Corozal Municipio
Culebra Municipio
Dorado Municipio
Fajardo Municipio
Florida Municipio
Gunica Municipio
Guayama Municipio
Guayanilla
Municipio
Guaynabo
Municipio
Gurabo Municipio
Hatillo Municipio
Hormigueros
Municipio
Humacao Municipio
Isabela Municipio
Jayuya Municipio
Juana Daz
Municipio
Juncos Municipio
Lajas Municipio
Lares Municipio
Las Maras
Municipio
Las Piedras
Municipio
Loza Municipio

---

---

76%
86%

---

----

----

77%
86%
83%

----

-----------------

-----------------

74%
85%
87%
74%
88%
87%
77%
88%
86%
73%
73%
74%
82%
82%
84%
86%

-----------------

--

--

71%

--

----

----

77%
87%
76%

----

-----

-----

79%
82%
88%
83%

-----

-----

-----

85%
90%
89%
89%

-----

--

--

84%

--

--

--

89%

--

Texas

Luquillo Municipio
Manat Municipio
Maricao Municipio
Maunabo Municipio
Mayagez
Municipio
Moca Municipio
Morovis Municipio
Naguabo Municipio
Naranjito Municipio
Orocovis Municipio
Patillas Municipio
Peuelas Municipio
Ponce Municipio
Quebradillas
Municipio
Rincn Municipio
Ro Grande
Municipio
Sabana Grande
Municipio
Salinas Municipio
San Germn
Municipio
San Juan Municipio
San Lorenzo
Municipio
San Sebastin
Municipio
Santa Isabel
Municipio
Toa Alta Municipio
Toa Baja Municipio
Trujillo Alto
Municipio
Utuado Municipio
Vega Alta Municipio
Vega Baja Municipio
Vieques Municipio
Villalba Municipio
Yabucoa Municipio
Yauco Municipio
Andrews County

------

------

79%
78%
91%
86%
75%

------

----------

----------

83%
88%
83%
88%
89%
86%
86%
79%
84%

----------

---

---

73%
81%

---

--

--

81%

--

---

---

78%
83%

---

---

---

70%
86%

---

--

--

87%

--

--

--

73%

--

----

----

80%
78%
77%

----

---------

---------

85%
79%
71%
86%
87%
84%
81%
12%

---------

Atascosa County
Bailey County
Bastrop County
Bexar County
Briscoe County
Brooks County
Cameron County
Camp County
Castro County
Cochran County
Collingsworth
County
Concho County
Crane County
Crockett County
Crosby County
Culberson County
Dallam County
Dallas County
Dawson County
Deaf Smith County
Dimmit County
Duval County
Ector County
Edwards County
El Paso County
Frio County
Gaines County
Garza County
Glasscock County
Gonzales County
Hale County
Hansford County
Harris County
Haskell County
Hemphill County
Hidalgo County
Howard County
Hudspeth County
Jeff Davis County
Jim Hogg County
Jim Wells County

------------

------------

13%
21%
10%
11%
10%
17%
30%
12%
19%
18%
13%

------------

-------------------------------

-------------------------------

26%
18%
12%
11%
14%
11%
17%
12%
18%
20%
15%
14%
11%
30%
17%
13%
39%
13%
12%
11%
16%
17%
13%
11%
31%
10%
35%
10%
16%
12%

-------------------------------

Karnes County
Kenedy County
King County
Kinney County
Kleberg County
Knox County
La Salle County
Lamb County
Limestone County
Lipscomb County
Martin County
Matagorda County
Maverick County
McMullen County
Menard County
Midland County
Moore County
Navarro County
Nueces County
Ochiltree County
Parmer County
Pecos County
Presidio County
Reagan County
Reeves County
San Saba County
Sherman County
Starr County
Sterling County
Sutton County
Terry County
Titus County
Travis County
Upton County
Uvalde County
Val Verde County
Ward County
Webb County
Willacy County
Winkler County
Yoakum County

------------------------------------------

-----------------------------------------8

10%
28%
12%
12%
12%
10%
24%
12%
13%
10%
10%
12%
45%
14%
10%
10%
18%
11%
10%
19%
23%
14%
37%
22%
23%
10%
14%
51%
12%
15%
12%
20%
11%
10%
12%
23%
11%
44%
20%
17%
22%

------------------------------------------

Zapata County
Zavala County
Virginia
Manassas city
Manassas Park city
Washington Adams County
Douglas County
Franklin County
Grant County
Yakima County

------

------

42%
28%
15%
16%
27%

------

-----

-----

13%
24%
16%
17%

-----