February 10, 2023

Section 1557 of the Affordable Care Act (ACA) prohibits discrimination based on race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 has been in effect since its enactment in 2010, with the U.S. Department of Health and Human Services’ (HHS) Office of Civil Rights (OCR) enforcing the provision.

However, the rules and guidance HHS has published to implement Section 1557 have been the subject of numerous lawsuits, dating back to when initial regulations were issued in 2016. The litigation has primarily focused on:

  • Which health programs and activities are subject to Section 1557’s nondiscrimination requirements; and
  • Whether sex discrimination includes discrimination based on gender identity, sexual orientation and termination of pregnancy.

This Compliance Bulletin provides a summary of the statutory requirements of Section 1557, highlights key federal court cases that have interpreted existing regulations and guidance, and outlines how HHS’ latest proposed rule would expand the scope of prior regulations. The latest updates and court rulings can be found on the OCR Section 1557 webpage.

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