HHS OCR Investigates Medical Schools and Hospitals for Race- or Sex-Based Programs

Title VI prohibits discrimination based on race, color, or national origin, and governs programs and activities that receive federal financial assistance. Similarly, Section 1557 of the Affordable Care Act prohibits discrimination based on race, color, national origin, sex, age, or disability in healthcare programs and activities. The final rule for Section 1557, issued on July 5, 2024, extends its application to any health program or activity that receives funding from HHS, including hospitals accepting Medicare or doctors who receive Medicaid payments. Individuals may file complaints with the DOJ or file suit in federal court for alleged violations of Title VI.

There have been other recent challenges to minority healthcare initiatives under Title VI and Section 1557. In 2024, the Wisconsin Institute for Law and Liberty (WILL), a nonprofit organization whose stated mission is to advance conservative principles through litigation, education and public discourse, filed a complaint on behalf of Do No Harm with the OCR under Title VI and Section 1557 against an academic medical center claiming that the academic medical center’s minority stroke program and clinic were examples of racial discrimination because they specifically targeted Black and Latino populations. Notwithstanding the justification that these programs helped understand and address the increased risk of stroke for those populations and racial health disparities, Do No Harm claimed that the non-Black and Latino members of the community were harmed by the center’s focus on racial minorities when “stroke and diabetes are leading causes of death in the United States” and “mental health conditions plague more than one in five adults.” Do No Harm claimed the programs were improperly “infected” with a “racially motivated focus.” At the time of this alert, OCR’s investigation into this complaint is ongoing.

We expect these investigations to increase. The March 7, 2025, investigation announcement encourages those who “believe that you or someone else has been discriminated against” on the basis of protected characteristics to file a complaint with OCR. This coincides with President Trump’s EOs directing federal agency heads to identify other companies and educational institutions who this administration deems are operating unlawful programs focused on racial and gender minorities. However, this potential increase in investigations is not without legal uncertainty, especially given the varying state-level policies leading to inconsistent approaches across different medical schools, hospital and health systems, and regions.

For many medical schools and hospitals, the evaluation or outright removal of diversity, equity, and inclusion or health equity language and criteria from mission statements and public-facing materials from various programs and initiatives signals a significant departure from previous commitments to diversity and inclusion, potentially affecting how these institutions are perceived by staff and the communities they serve. As scrutiny increases, educational institutions and hospitals and health systems should carefully assess the eligibility criteria for their programs and initiatives based on race, sex, national origin, or color, as programs that are open to all may be less susceptible to scrutiny. Further, institutions should review marketing of their programs and initiatives to the public to ensure they are not making statements or representations implying that race or sex is a criterion for acceptance or participation.