This paper aims to investigate three government mechanisms to promote the availability of bilingual and interpretive services in health care and in the United States: civil rights law, federal and state legislation, and the regulation of federally financed managed care programmes. By looking at the players, circumstances and specific application of these mechanisms in three states, it becomes possible to draw lesions about barriers to progress and elements of success that are useful in developing a strategy for promoting language-accessible health services in other locales. While this paper focuses on governmental processes specific to the United States, the discussion of how to organize for positive change in language access to health care is applicable to other countries.