According to the 2000 U.S. Census, 47 million residents—nearly one in five—speak a language other than English at home. During the last few decades, this group has more than doubled (from 11.0% in 1980 to 17.9% in 2000), whereas the population that speaks only English has decreased (from 89% in 1980 to 80% in 2007; Shin & Bruno, 2003; Shin & Kominski, 2010). Similarly, the 2000 U.S. Census reported that more than 40 million U.S. residents do not speak the same language as their health care providers, and more than 21 million are considered limited English proficient (LEP), speaking English less than fluently. California has some of the most racially, ethnically, and linguistically diverse communities in the United States, with 26% of its residents being foreign born—the highest percentage of any state in the nation (Grant Makers in Health, 2003). California represents one of the fastest growing LEP populations in the country, with a growth of 42% between 1990 and 2000. In 2005, 42.3% of Californians 5 years of age and older were considered LEP, compared with 19.4% of the total U.S. population (Moreno, Otero-Sabogal, & Newman, 2007).