When a family visited a Portland hospital for a fifth time to help their developmentally disabled son, Juan Pablo Loyola saw their desperation when no one understood them. He also saw a disconnect.
Loyola, a medical interpreter who goes by “JP,” recalled working through “layers of misunderstanding” between the Spanish-speaking family and the doctors. Eventually, he said, the team was able to determine the problem: the 5-year-old’s gastronomy tube, a surgical device that provides nutrients, was the wrong size and was hurting him.
Even with his training in medical terminology and ability to navigate cultural nuance, Loyola said he is paid as low as $20 an hour. Like most interpreters in Oregon, he’s a freelance contractor who has to pay for his own insurance, taxes and retirement. He’s just getting by, like many other interpreters.
“We are kind of like the last step in this waterfall of contracts,” Loyola said, referring to the administrative layers between interpreters and their pay.
Complaints like Loyola’s have persisted despite the state’s goals of eliminating health disparities by 2030 and professionalizing medical interpreting. State data suggests those efforts are falling short. Oregon’s Medicaid insurers —known as coordinated care organizations — provided trained interpreters for just 15% of visits where a patient needed interpretation in 2024.
Oregon Interpreters in Action, the union that represents more than 2,000 trained interpreters, say interpreters’ low pay means the state won’t have the workforce needed for those goals. The union has been negotiating with the Oregon Health Authority for more than five years for a contract and is now pressing to set a minimum payment standard for appointments covered by the Medicaid-funded Oregon Health Plan.
Health authority spokesperson Kristen Lambert said in an email that Oregon was one of the first states to create training and credentialing programs for interpreters, “recognizing that language services are not optional—they are critical to addressing health inequities and ensuring every OHP member can fully participate in their care.”
The authority is working on a system to streamline interpreters’ pay. But for now, interpreters’ pay is determined by CCOs, which manage Medicaid benefits and contract with language access companies, she said.
The union’s demand comes amid the slow rollout of an online system meant to connect interpreters more directly to appointments. It also comes as the Oregon Health Plan, which provides insurance for 1.4 million Oregonians, is already struggling to cover costs, and while deep federal cuts loom.
Grunt work?
After moving to the U.S. from Venezuela about a decade ago, Carlos Burgos found jobs driving trucks, lighting maintenance and other physically taxing “grunt work.”
One day, he was at a physical therapist’s office for old injuries to his back and shoulder, when he noticed someone was working as a medical interpreter for another patient.
“And I thought, ‘I’m sure that guy’s shoulder doesn’t hurt because of his work,’” Burgos recalled, who became a medical interpreter about three years ago.
Being an interpreter, he said, pays better than other jobs and he likes helping patients. But he said he didn’t have insurance for his first two years working as an interpreter. He has to pay his own taxes as a freelancer contractor, and much of his pay still goes to rent and other expenses.
Both Burgos and Loyola said the mileage reimbursement paid by language access companies varies and often does not cover the cost. Loyola said several companies only cover mileage if an appointment is at least 15 miles away, meaning there’s no reimbursement for a day’s work. They both said the same about how they are paid for canceled appointments.
In 2022, Oregon began requiring health care providers paid with public funds to hire from a registry of 3,000 interpreters with approved training. There are exceptions if a provider can prove an interpreter is proficient in a language or if they can’t find one they need from a list.
Those exceptions are widely used, according to an analysis included in a report on Oregon’s health care workforce needs. Coordinated care organizations did not use an interpreter from the registry for about a third of their appointments in 2022 and more than half in 2023.
Burgos is currently registered as a qualified interpreter. He said he could become a certified interpreter with more training, but he said he is in no hurry because there is already plenty of demand and language access companies might actually be less likely to hire him.
“We need to figure out how to get better conditions for us and feel less exploited,” he said.
Loyola said he can make as much as $38 for an appointment. But asking for more money might mean a company will give work to a less-expensive interpreter, he said. Interpreters also worry they will lose jobs if they speak out about working conditions or participate in union activities, he added.
Street Roots reached out for comment to multiple language access companies, but none responded by press time.
Joshua Pennise, president of the Association of Language Companies, said in an email that there is more to interpreters’ pay and how companies provide services.
Language access companies aren’t profiting from the difference between what Medicaid pays for interpretation services and what the interpreter is paid, he said. Instead, he said the difference also goes to covering what he called “the real cost” of operating a language access company. That includes 24/7 operations, recruitment, credentialing, scheduling, billing, technology, quality assurance and regulatory compliance, he said.
He added that language access companies share the interpreters’ goal of a sustainable system.
“Achieving that will require collaboration among interpreters, companies, insurers, and the state to modernize reimbursement models so they reflect the true cost of delivering high-quality language access,” he said.
‘Black box’
Clinics and hospitals often work with language access companies that provide interpreters in person or remotely, said Amanda Wheeler-Kay, vice president of the Oregon Society of Translators and Interpreters. She said it is rare for interpreters to be contracted directly by a clinic because outside companies offer more flexibility and range of languages.
Wheeler-Kay, also a member of the interpreters’ union, said that arrangement can create an information imbalance as interpreters try to negotiate with companies.
Medicaid payments to medical interpreters flow from the health authority to coordinated care organizations, which in turn pay language access companies for their contracted interpreters.
Burgos, who is on the union’s bargaining team, likened CCOs to a “black box,” saying it’s not clear how much they pay for interpreters and how much goes to intermediaries.
However, Milana Grant, spokesperson for Oregon AFSCME, the union’s parent organization, said in a statement that the interpreters’ bargaining team obtained a contract showing one CCO paid an average minimum of $88 per assignment. Interpreters received just $20 to $30 an hour, she said.
The health authority disputes the union’s contention that it can control how much CCOs pay interpreters, and instead sets standards to ensure Medicaid patients get language support, according to spokesperson Lambert.
Health Share of Oregon, the largest CCO that covers more than 400,000 people in the Portland area, did not respond to Street Roots’ questions or interview request sent to its media inbox. Instead, Health Share responded with an automated customer service email.
CareOregon, another large player in Oregon’s Medicaid system that owns two CCOs, directed Street Roots’ questions to the health authority.
The Oregon Health Plan pays less for health care services than commercial plans, meaning that health care providers have had to find a mix of patients to be financially viable. But Grant said in an email that “interpretation for OHP patients is by far the most in demand type of interpretation” and that most interpreters would not be able to find enough commercial work to be viable.
CCOs have recently struggled to cover rising health care costs, and the health authority stepped in last fall with increased payments to keep them afloat.
Previously, CCOs resisted changes to the state’s arcane Medicaid budgeting process. Oregon lawmakers considered a bill in 2023 that would have given the health authority greater flexibility in Medicaid spending on health-related social needs. However, the bill perished after CCOs objected that it would disrupt the budgeting process.
Hopes delayed
Loyola came to the U.S. from Chile in 2015 on a visa that allowed him to work as a physical therapist. He often served as an unofficial interpreter in hospitals in Ohio, Indiana and Florida.
Like many health care workers, Loyola said he became burnt out after working at “150%” for years at a Florida hospital. In 2024, he packed up his apartment and moved across the country to Portland, where he became a medical interpreter.
Washington state uses an online system that allows medical interpreters to directly sign up to serve Medicaid appointments. Interpreters in Washington also have a contract that pays a minimum of about $50 an hour for in-person appointments, and less for over-the-phone or virtual interpreting.
Oregon lawmakers passed a bill backed by the union in 2024, creating a similar online system that would allow interpreters to be paid directly. The bill passed despite unanswered questions about its cost.
The bill allows the health authority to directly pay interpreters, but it can’t do so until the Health Care Interpreter Scheduling and Claims Portal is online, according to spokesperson Lambert. The portal will ensure that appointments are billable, verified, auditable and don’t duplicate payments, she added.
The health authority’s website states that the “project involves many complex systems and a long contracting process, while aiming to have it ready by 2027.”
In the meantime, Loyola would like to get his car fixed. He’d like to buy new clothes. At age 40, he hasn’t saved for retirement. He hasn’t been home to Chile in five years. But he doesn’t want to leave interpreting, which he called “an immediate love story” and an opportunity to support immigrants.
Loyola said many interpreters are immigrants who came to the U.S. in search of a better life. But now he’s not sure how he will pay rent.
Correction: An earlier version of this story misstated the number of members in Oregon Interpreters in Action.
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This article appears in February 3, 2026.