About 8% of people ages five and older in the U.S. have limited English proficiency, and this group is three times as likely as English proficient individuals to be uninsured, according to a new KFF analysis.

Those with limited English proficiency are individuals who have restricted ability in reading, writing, speaking or understanding English, according to the U.S. Department of Health and Human Services.

Most people with limited English proficiency are Spanish-speaking Hispanic adults, according to KFF. Hispanic people represent 62% of the limited English proficiency population, and 22% are Asian. The top five languages spoken by this group are Spanish (63%), Chinese (7%), Vietnamese (3%), Arabic (2%) and Tagalog (2%).

About seven out of 10 individuals with limited English proficiency live in a household with at least one full-time worker (similar to those who are English proficient). However, this population is more likely to work in jobs with lower wages, such as manufacturing, food services and construction industries. This is likely due to “lower educational attainment,” as adults with limited English proficiency are more than five times as likely as English proficient adults to have less than a high school education.

Of nonelderly people with limited English proficiency in 2021, 29% were uninsured, versus 9% of English proficient people. About 43% of nonelderly individuals with limited English proficiency had private insurance, compared to 67% of English proficient individuals. Another 28% of those with limited English proficiency were covered by Medicaid, compared to 24% of English proficient people.

“Individuals with [limited English proficiency] are more likely to be employed in lower-wage jobs and industries that often do not offer employer-sponsored coverage and may have difficulty affording coverage even when it is offered,” the researchers explained. “Medicaid helps to fill some of this gap in private coverage for people with [limited English proficiency], but does not fully offset the difference, leaving people with [limited English proficiency] more likely to be uninsured.”

Hispanic individuals with limited English proficiency had the highest uninsured rate at 37%, compared to 31% of American Indian and Alaska Native people, 23% of Native Hawaiian and Other Pacific Islander people, 19% of Black people, 16% of White people and 10% of Asian people.

There have been improvements in uninsured rates for those with limited English proficiency due to the Affordable Care Act. Before the ACA, 46% of this population was uninsured, versus 29% in 2021. However, these improvements could be affected by Medicaid redeterminations — the process for determining if enrollees are still eligible for Medicaid — which resumed in April after a hiatus during the Covid-19 public health emergency.

“Complex enrollment and renewal processes have historically been barriers to obtaining and maintaining Medicaid coverage,” KFF said. “Enrollees with [limited English proficiency] are at particular risk for experiencing difficulties, as they may face added challenges understanding and completing tasks or forms due to language barriers, particularly if they are not provided translated materials.”

To combat these issues, KFF said there need to be efforts to help those with limited English proficiency during redeterminations, such as funding and staffing call centers, providing notices in the top 15 languages spoken by people with limited English proficiency and engaging with local communities.

But regardless of whether individuals with limited English proficiency have health insurance, they still face barriers in accessing healthcare, KFF added. This includes a lack of understanding of healthcare information, reduced medication adherence, more ordering of medical tests by providers, higher rates of medical errors and reduced primary care utilization. But offering “timely access to language assistance” can help reduce these challenges, including oral interpretation and written translations.

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