OCR Health Equity Factsheet

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) implements statutes that are critical to health equity, including federal civil rights laws, conscience and religious freedom laws, the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, and Breach Notification Rules, and the Patient Safety Act and Rule, which together protect fundamental rights of non-discrimination, conscience, religious freedom, and health information privacy. OCR’s Strategic Plan provides a framework for how compliance work, partnerships, and operations can implement the Biden-Harris Administration’s commitment to advancing health equity, as described in President Biden’s Executive Orders 14076, 13985, 14091 and 14110.

OCR adopts the definition of health equity articulated in Executive Order 14091 of consistent and systematic treatment of all individuals in a fair, just, and impartial manner, including individuals who belong to communities that often have been denied such treatment, such as Black, Latino, Indigenous and Native American, Asian American, Native Hawaiian, and Pacific Islander persons and other persons of color; members of religious minorities; women and girls; LGBTQI+ persons; persons with disabilities; persons who live in rural areas; persons who live in United States Territories; persons otherwise adversely affected by persistent poverty or inequality; and individuals who belong to multiple such communities.

OCR is working to advance health equity through its rulemaking and enforcement activities, both of which allow OCR to effectuate and enforce standards of the law to prevent non-discrimination and advance fair, just and equal treatment in Federally funded health care programs and activities.

Disability and Aging

Health Equity Goal: Ensure non-discrimination and increase access to services in the community for persons with disabilities who want to return to their communities from institutional settings or are at risk of institutionalization.

• Improve opportunity for people living with disabilities by resolving individual and systemic complaints alleging Olmstead violations and by increasing educational activities for the public that raise awareness of OCR’s enforcement authorities, including press releases on Olmstead resolutions, internal and external presentations, and website updates. Olmstead enforcement strategies include early complaint resolutions, systemic relief, technical assistance, guidance, and outreach.
  
  Impact: Ensures individuals who have been wrongfully institutionalized or are at risk of institutionalization are aware of their rights and receive the services to which they are legally entitled in their own homes and communities.

Health Equity Goal: Combat and prevent discrimination and advance opportunities for individuals with disabilities through rulemaking.

• Update and clarify critical regulatory provisions that help persons with disabilities accesshealth and human services and prohibit discrimination on the basis of disability under Section 504 of the Rehabilitation Act. The rule updates Section 504 to align with other disability non-discrimination laws and adds specifics to prevent and respond to discrimination on the basis of disability in health and human services.
  
  Impact: Will help protect the general health and wellbeing of individuals with disabilities by clarifying what counts as discriminatory medical treatment and improving patients’ ability to have meaningful access to necessary medical equipment and health and human service programs.
• Issued guidance on civil rights protections for people with disabilities that makes clear that civil rights protections remain in full force and effect during disasters or emergencies, including during the COVID-19 pandemic.
  
  Impact: Improves protections for people with disabilities during public health disasters and emergencies.
• Issued guidance on how disability non-discrimination laws apply to certain people - affected by COVID-19. The guidance provides clarity on “Long COVID” and disability rights under the ADA, section 504, and Section 1557. The guidance also provides resources for additional information and best practices.
  
  Impact: Helps educate the public on how disability rights laws apply to conditions related to the COVID-19 pandemic.

Non-discrimination in Health Care

Health Equity Goal: Ensure non-discriminatory access to health care services and supporting persons with disabilities seeking access to medication.

• Resolved complaints with national pharmacy chains to ensure timely access to medications for women and persons with disabilities, including access to prescriptions for individuals with disabilities. As a result, the pharmacies implemented new processes to promote access to medication by preventing potential delays.
  
  Impact: Improves access to medication so individuals with disabilities are able to get timely access to vital prescriptions.

Health Equity Goal: Advance non-discrimination in health and human services programs through rulemaking.

• Released proposed revisions to regulations implementing Section 1557 of the Affordable Care Act (ACA) that restores and strengthens non-discrimination civil rights protections for LGBTQI+ people, women, and individuals seeking care in Federally funded health programs and activities. The proposed rule affirms protections against discrimination on the basis of sex, including sexual orientation, gender identity, and pregnancy, in the provision of health services.
  
  Impact: Improves non-discrimination protections for marginalized communities, including gender diverse individuals, LGBTQI+ individuals, pregnant people, individuals with limited English proficiency, and individuals with disabilities. The proposed Section 1557 Rule would expand the applicability of non-discrimination standards in health care to health coverage, including limited-duration health plans, and to the Department’s activities related to health programs such as the Medicare and Medicaid programs and the Indian Health Service.
   
• Released a proposed update to the HHS Grants Rule that prohibits sex discrimination in specific HHS grant programs by clarifying that the prohibition on discrimination on the basis of sex includes discrimination on the basis of sexual orientation and gender identity.
  
  Impact: Clarifies non-discrimination protections in specific HHS grant programs including services and grants that provide aid to refugees, assistance to people experiencing homelessness, substance use treatment and prevention, community mental health services, maternal and child health services, and community services. 

Operations and Outreach

Health Equity Goal: Provide outreach and technical assistance to the public to advance our health equity activities in civil rights and HIPAA.

• Ensured communications are available to the public by widely publicizing OCR’s dedicated email for inquiries and monitoring and responding to inquiries on a daily basis, with over 55,000 responses to public inquiries per year.
  
  Impact: OCR connects with the public by regularly responding to inquiries on subjects such as civil rights, religious conscience, and health information privacy through providing technical assistance, information on rulemaking, and, at times, speaking directly with staff.
• Translated the OCR Complaint Portal into 15 languages and updated the complaint   form to include gender inclusive language.
  
  Impact: Increase the accessibility of OCR services for people with different language access needs and gender identities.
• Updated OCR’s toll-free support line to provide the consumer with self-service options and provide OCR the ability to collect data on calls received to serve callers better.
  
  Impact: Improves ability to provide individuals information more efficiently, re-route their calls to other agencies, and start to identify trends from data received from callers. 

Language Access

Health Equity Goal: Advance meaningful access for individuals with limited English proficiency and effective communication for individuals with disabilities by issuing guidance to states and health care providers and by ensuring the Department delivers linguistically appropriate and accessible programs and services

• Relaunched the Language Access Steering Committee and released an HHS Language Action Plan setting forth practical guidance, best practices, and action steps Operating and Staff Divisions can use to develop their own, agency-specific language access plans. The plan also calls for agencies to collect data regarding their language access services.
  
  Impact: The Language Access Plan helps Departmental agencies ensure access to timely, quality language assistance services including translation and effective communication services that will have a disproportionately greater impact on individuals with disabilities and individuals with limited English proficiency. The data collection component of the Language Access Plan also helps agencies identify and address communication barriers to equal opportunity that underserved communities face.
   
• Issued a letter reminding states of their obligations under federal civil rights laws to ensure that individuals and families continue to have access to effective communication in Medicaid and Children’s Health Insurance Program coverage as states return to normal processes to redetermine enrollees’ eligibility, (i.e., post COVID-19 public health emergency Medicaid and CHIP “unwinding”).
  
  Impact: Improves compliance with civil rights requirements by requiring states to meet individuals’ communication needs. This letter helped to improve states’ understanding of their responsibility to provide effective communication in the Medicaid Unwinding process and addresses communication needs for individuals identified in EO 14091, Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. OCR’s letter reminded states of their obligations to ensure non-discrimination on the basis of race, color, national origin, and disability, and anticipates that this work will bolster state efforts to retain children and families on Medicaid programs, reducing the medical and financial risks caused by coverage gaps.
   
• Issued guidance on federal non-discrimination laws that require accessibility for people with disabilities and limited English proficiency in health care provided via telehealth.
  
  Impact: Helps health care providers better understand their non-discrimination obligations and helps patients better understand their rights under federal law.

Environmental Justice

Health Equity Goal: Address health disparities and reduce environmental risks for underserved communities by ensuring compliance with federal civil rights laws.

• Initiated the first-ever federal government environmental justice enforcement action over a lack of wastewater disposal systems in Lowndes County, Alabama, where the majority of residents are Black and low income. Entered a Settlement Agreement that requires the State of Alabama to take several actions to address the problem, including assessing need for wastewater disposal, developing a public health and infrastructure plan, seeking funding and technical assistance, and adopting a moratorium on enforcing criminal statutes and liens on properties that lack approved wastewater disposal systems.
  
  Impact: Helps residents of Lowndes County access clean water and public health resources. The Settlement Agreement requires the Alabama Department of Public Health to take a number of measures, including launching a public health campaign, providing educational materials on the impacts of sewage to health care providers, and creating a sustainable and equitable public health infrastructure improvement plan. This action also creates a model for future actions under Title VI and Section 1557.

Substance Use Disorder and Related Conditions

Health Equity Goal: Increase awareness of non-discrimination laws that protect individuals involved in child welfare who are in recovery from substance use disorder.

• Resolved a complaint that a county child welfare agency denied an individual the opportunity to apply to be a foster parent because she receives medication for the treatment of substance use disorder. The investigation and subsequent settlement identified systemic concerns regarding the state child welfare agency’s oversight of county child welfare agencies’ compliance with federal disability rights laws.
  
  Impact: Protects the civil rights of individuals with substance use disorders. OCR enforced its authorities through a voluntary resolution agreement that required the state welfare agency to take a number of corrective actions that adopt OCR non-discrimination standards for individuals living with a substance use disorder.

Health Equity Goal: Increase Health Care Coordination and Confidentiality for Patients with Substance Use Challenges

• Published a Final Rule on Confidentiality of Substance Use Disorder Patient Records to bring its requirements into closer alignment with HIPAA Rules.
  
  Impact: Increases coordination among providers in any setting, including those who treat individuals with substance use disorder and clarifies protections surrounding records disclosure to help address concerns that discrimination and fear of prosecution may deter individuals with substance use disorder from seeking health care. Such protections include civil enforcement and requiring reporting of breaches of substance use disorder treatment records.
   
• Introduced a video series on federal disability rights protections that apply to some individuals in recovery from an opioid use disorder. The five-part series discusses   protections that apply to some individuals in recovery from an opioid use disorder and       provides an overview of medications for opioid use disorder (MOUD).
  
  Impact: Provides clear and accessible guidance on disability protections for individuals in recovery for opioid use disorder.

Health Information Privacy

Health Equity Goal:  Advance health equity and the attainment of the highest level of health for all people by supporting the privacy and security of individuals’ health information.

• Protected patient privacy and access to health care by issuing Guidance on the HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care, which addresses when the HIPAA Privacy Rule permits disclosure of protected health information without an individual’s authorization and the limitations on these disclosures.
  
  Impact: Helps improve privacy protections for patients seeking reproductive health care. Infringements on reproductive health privacy are likely to have a disproportionate impact on women and communities that have been historically underserved.
   
• Released guidance on Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet, which explains that the HIPAA Rules do not apply to individuals’ health information when it is stored or accessed using a personal mobile device. This guidance also explains how to turn off location services on Apple and Android devices and identifies best practices for selecting apps, browsers, and search engines that are recognized as supporting increased privacy and security.
  
  Impact: Supports patients’ privacy rights and expectations and advances confidence in the confidentiality of patient communications with their health care provider and the privacy of their health records. The guidance will help provide accessible information on health information privacy, including to individuals who may be reliant on telehealth services and those who may have not been previously exposed to information on data privacy.
   
• Support Patient Privacy in Reproductive Health Care Privacy by publishing a notice of proposed rulemaking on the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, which would prohibit the use or disclosure of protected health information to investigate or prosecute patients, providers, and others involved in the provision of lawful reproductive health care.
  
  Impact: Advances trust in the patient-provider relationship and ensures that patients’ private medical records will not be disclosed and used against people for merely seeking, obtaining, providing, or facilitating lawful reproductive health care. Infringements on health information privacy related to reproductive health care are likely to have a disproportionately greater effect on women, individuals of reproductive age, and individuals from communities that have been historically underserved.