HHS Enforcement Letter on DEI and ACA Section 1557 Compliance Practical Law The Journal
On May 6, 2025, HHS issued a 'Dear Colleague' letter addressing nondiscrimination requirements under:
Title VI of the Civil Rights Act of 1964 (Title VI).
Section 1557 of the Affordable Care Act (ACA) (for more information, see ACA Section 1557 Compliance for Health Coverage Toolkit on Practical Law).
The Equal Protection Clause of the US Constitution.
Directed at medical schools that receive federal funding from HHS, the letter focuses on the schools' use of race-based criteria in admissions and hiring (including under some DEI programs). (HHS, Dear Colleague Letter (May 6, 2025); HHS, Press Release (May 6, 2025).)
ACA Section 1557
ACA Section 1557 prohibits individuals from being excluded from participation in, denied the benefits of, or subject to discrimination under a health program or activity that receives federal financial assistance on specified grounds. Section 1557 incorporates the grounds for prohibited discrimination under four civil rights laws. One of these laws, as HHS notes in the May 2025 letter, is Title VI, which bars discrimination on the basis of race, color, and national origin (42 U.S.C. §§ 2000d to 2000d-7; for more information, see June 2020 Final Regulations Under ACA Section 1557: Nondiscrimination in Health Programs and Activities on Practical Law).
The second Trump administration has expressly referenced ACA Section 1557 in recent investigatory announcements of race-based criteria and DEI programs, suggesting that these issues may eventually be addressed in additional proposed regulations under Section 1557 (for more information, see Trump Administration Investigates Hospitals' DEI Programs Using ACA Section 1557 on Practical Law). If so, the substantive scope of the next set of Section 1557 regulations will likely differ significantly from the version of these regulations finalized under the Biden administration one year ago (for more information, see ACA Section 1557 Compliance for Health Coverage Toolkit on Practical Law). Counsel should monitor Section 1557 guidance from the Trump administration and settlement agreements involving the administration's investigatory efforts in this space.
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