The availability of language services for patients with limited English proficiency has become a standard of care in the United States. Finding the resources to pay for language programs is challenging for providers, payers, and policymakers. There is no federal payment policy and states are developing policies using different methodologies for determining costs and reimbursement rates. This paper establishes a conceptual framework that identifies program costs, can be used across health care entities, and can be understood by administrators, researchers, and policymakers to guide research and analysis and establish a common ground for informed strategic discussion of payment and reimbursement policy. Using case study methods, a framework was established to identify costs and included determining the perspective of the cost analysis as well as distinguishing between the financial accounting costs (direct, indirect, and overheard costs) and the economic opportunity and subsequent utilization costs.