Accessibility requirements don’t always make national headlines. But for California Managed Care Plans serving Medi-Cal members, recent guidance from the Department of Health Care Services (DHCS) carries important operational implications.
We dug into DHCS All Plan Letter (APL) 25-016 so you don’t have to.
APL 25-016 updates and replaces earlier guidance (APL 22-002) and reinforces expectations around providing written communications in alternative formats, including braille, audio, large print, and accessible electronic files. While the obligation to provide effective communication has long existed under federal disability law, this update, which came into effect in November 2025, clarifies how member format preferences are tracked and how plans are expected to act on them.
For healthcare organizations already managing complex regulatory requirements, the practical questions are familiar:
What exactly is required?
How does this affect existing workflows?
And are our current systems aligned with these expectations?
This moment calls for clarity – and a closer look at operational readiness.
What APL 25-016 Changes
Under APL 25-016, Medi-Cal members are entitled to receive written communications in their selected alternative format at no cost. Recognized formats include:
- Braille
- Audio (such as audio CD or other audio media)
- Large print (minimum 20-point Arial font)
- Accessible electronic formats
- Other formats upon request through county or DHCS systems
The guidance reinforces compliance with ADA Title II and Medi-Cal contract requirements. But one of the most significant elements is not the list of formats. It’s how member preferences are operationalized.
Alternative Format Selections (AFS) are transmitted to Managed Care Plans through the 834 enrollment file, and the Medi-Cal Eligibility Data System (MEDS) serves as the system of record.
In other words, accessibility preferences are structured data, and they are expected to connect directly to communication workflows.
From Policy to Process
As format preferences move through enrollment systems, accessible communication becomes less about occasional accommodation and more about consistent execution.
Managed Care Plans and delegated providers are expected to:
- Receive and store AFS data
- Maintain workflows that trigger production of the selected format
- Ensure effective communication consistent with ADA standards
- Support members in updating format preferences when needed
For some organizations, existing processes may already support this structure. For others, this guidance may highlight areas where braille, audio, or large print production has historically been handled manually or through separate vendors.
The question isn’t whether accessibility matters. It’s whether it’s operationalized.
Why This Matters Now
APL 25-016 reinforces expectations tied to Medi-Cal contract compliance and federal disability law. Plans are subject to state oversight and monitoring processes, making consistency in accessible communications increasingly important.
At the same time, this is not just about compliance.
Members who rely on alternative formats depend on accessible communications to understand benefits, eligibility decisions, and care options. Accuracy, timeliness, and format integrity directly affect their ability to engage with the healthcare system.
As regulatory guidance becomes more data-driven and system-integrated, alternative format fulfillment becomes part of the broader conversation about scalable, compliant communication.
The Operational Reality
Many healthcare organizations have robust translation workflows but less formalized processes for braille or audio production. In environments where these requests have historically been infrequent, fulfillment may not have been fully integrated into core systems.
APL 25-016 makes format preference more visible through enrollment data. That visibility encourages plans to evaluate whether accessible formats are reliably connected to production workflows.
This doesn’t necessarily require dramatic change. It may simply mean reviewing how AFS data flows through your organization and confirming that the right triggers, partners, and processes are in place.
LanguageExpress™: Purpose-Built for High-Volume, Regulated Communication
Healthcare communication operates at the intersection of speed, accuracy, and compliance. LanguageExpress™ was developed for exactly that environment.
Our tech-enabled, hybrid translation workflow combines intelligent automation with human oversight to deliver accurate, industry-specific translations in more than 300 language combinations. With availability 24x7x365, we help organizations manage high-volume communication needs without delays.
Accessibility is part of that same operational discipline.
In addition to multilingual translation, LanguageExpress™ supports large print, audio, accessible digital formats, and braille, backed by a dedicated team of in-house braillists to ensure quality and consistency. We also offer end-to-end support, from composition and formatting through production and direct-to-member fulfillment.
For organizations responding to guidance such as APL 25-016, this integrated approach enables alternative-format delivery to align more seamlessly with enrollment data, regulatory requirements, and member-communication workflows.
Clarity Supports Compliance — and Confidence
Regulatory updates often serve as checkpoints. They provide an opportunity to pause, evaluate, and ensure alignment between policy, systems, and execution.
For California Managed Care Plans, APL 25-016 is one of those moments.
If your team is reviewing how Alternative Format Selection data connects to communication workflows, or assessing how braille and audio production are managed, now is a good time to confirm that your processes are positioned for consistency and scale.
If you’re exploring ways to strengthen accessible communication while maintaining efficiency, BIG is here to help.
