HEALTH & HUMAN SERVICES
Hispanics are one of the most undeserved communities in health and human services, primarily due to language and cultural barriers as well as concerns about citizenship and eligibility.
LULAC encourages public education on the existing laws that outlaw discrimination in this arena and supports the investigations and alternative dispute resolution strategies of the Office for Civil Rights of the U.S. Department of Health and Human Services.
The Office for Civil Rights’ (OCR) legal authority to ensure nondiscrimination cuts across all of the programs and services funded by the Department of Health and Human Services (HHS). From hospitals and nursing homes, to Head Start centers and social service agencies, the public expects to receive high quality services free from discrimination based on race, color, national origin, disability, age, sex and religion.
As the primary defender of the public’s right to nondiscriminatory access to and receipt of services, OCR historically has played a major role in a variety of civil rights initiatives in the health and human service context, such as desegregating hospitals and issuing regulations to open up facilities and services to persons with disabilities.
OCR recognizes that it also has exciting challenges ahead. The evolution to managed care, the implementation of welfare reform, and the continued prevalence of racial and ethnic disparities in health status raise a host of new civil rights challenges for OCR.
Because we are aware of our broad responsibilities to enforce anti-discrimination laws, our strategic plan focuses on key areas of concern. These include race or national origin discrimination in health care services, services to persons with limited English proficiency, and discrimination against persons with HIV/AIDS.
The Department of Health and Human Services, through the Office for Civil Rights, promotes and ensures that people have equal access to and opportunity to participate in and receive services in all HHS programs without facing unlawful discrimination. Through prevention and elimination of unlawful discrimination, the Office for Civil Rights helps HHS carry out its overall mission of improving the health and well-being of all people affected by its many programs.
LULAC affirms its commitment to the elimination of discrimination towards Hispanics in all areas of health and human services.
Through excellence in investigations, voluntary dispute resolution, enforcement, technical assistance, policy development and information services, OCR will protect the civil rights of all individuals who are subject to discrimination in health and human services programs.
As an organization of diverse and empowered individuals, OCR, through partnerships with customers and suppliers, will ensure equality in the delivery of services to HHS beneficiaries. Working collaboratively with HHS Operating and Staff Divisions to make civil rights concerns an integral part of HHS programs, OCR will use its human and technical resources efficiently to accomplish its mission. The success of OCR’s compliance program will be reflected in the full participation of persons of diverse backgrounds and capabilities in health and human services programs nationwide.
Health & Human Services Institutions or Programs
Health and social service programs and
In the course of its enforcement activities, OCR has found that persons who lack proficiency in English frequently are unable to obtain basic knowledge of how to access various benefits and services for which they are eligible, such as the State Children’s Health Insurance Program (SCHIP), Medicare, Medicaid or Temporary Assistance to Needy Families (TANF) benefits, clinical research programs, or basic health care and social services.
For example, many intake interviewers and other front line employees who interact with LEP individuals are neither bilingual nor trained in how to properly serve an LEP person. As a result, the LEP applicant all too often is either turned away, forced to wait for substantial periods of time, forced to find his/her own interpreter who often is not qualified to interpret, or forced to make repeated visits to the provider’s office until an interpreter is available to assist in conducting the interview.
The lack of language assistance capability among provider agency employees has especially adverse consequences in the area of professional staff services, such as health services. Doctors, nurses, social workers, psychologists, and other professionals provide vitally important services whose very nature requires the establishment of a close relationship with the client or patient that is based on empathy, confidence and mutual trust. Such intimate personal relationships depend heavily on the free flow of communication between professional and client.
This essential exchange of information is difficult when the two parties involved speak different languages; it may be impeded further by the presence of an unqualified third person who attempts to serve as an interpreter.
OCR’s Response-Guidance Policy on Limited English Proficient Persons
OCR issued internal guidance to its staff in January 1998 on a recipients obligation to provide language assistance to LEP persons. That guidance was intended to ensure consistency in OCR’s investigation of LEP cases. This current guidance clarifies for recipient/covered entities and the public, the legal requirements under Title VI that OCR has been enforcing for the past 30 years.
This policy guidance is consistent with a Department of Justice (DOJ) directive noting that recipient/covered entities have an obligation pursuant to Title VI’s prohibition against national origin discrimination to provide oral and written language assistance to LEP persons.
It is also consistent with a government-wide Title VI regulation issued by DOJ in 1976, “Coordination of Enforcement of Nondiscrimination in Federally Assisted Programs,” 28 C.F.R. Part 42, Subpart F, that addresses the circumstances in which recipient/covered entities must provide written language assistance to LEP persons.
Who is Covered Under the LEP Guidance Policy?
All entities that receive Federal financial assistance from HHS, either directly or indirectly, through a grant, contract or subcontract, are covered by this policy guidance. Covered entities include:
1) any state or local agency, private
institution or organization, or any public or private individual that
Examples of covered entities include but are not limited to hospitals, nursing homes, home health agencies, managed care organizations, universities and other entities with health or social service research programs, state, county and local health agencies, state Medicaid agencies, state, county and local welfare agencies, programs for families, youth and children, Head Start programs, public and private contractors, subcontractors and vendors, physicians, and other providers who receive Federal financial assistance from HHS.
Basic Requirements of LEP Guidance Policy
A recipient/covered entity whose policies, practices or procedures exclude, limit, or have the effect of excluding or limiting, the participation of any LEP person in a federally-assisted program on the basis of national origin may be engaged in discrimination in violation of Title VI. In order to ensure compliance with Title VI, recipient/covered entities must take steps to ensure that LEP persons who are eligible for their programs or services have meaningful access to the health and social service benefits that they provide. The most important step in meeting this obligation is for recipients of Federal financial assistance such as grants, contracts, and subcontracts to provide the language assistance necessary to ensure such access, at no cost to the LEP person.
2. National origin discrimination & Immigrant Access
Citizenship status is a second barrier for Latinos in accessing health and human services programs. Fear of disclosing personal information often leads immigrant Latinos to not apply for critical services. The Departments of Health and Human Services (HHS) and Agriculture (USDA) have issued policy guidance clarifying when states may or may not request information about citizenship, immigration status, and Social Security numbers on applications for Medicaid, SCHIP, Temporary Assistance to Needy Families (TANF), and food stamp benefits.
Many states have developed joint applications for a number of programs, such as Medicaid, TANF and food stamps, to make it easier for individuals to receive the services they need. In many situations, this has resulted in the inclusion of questions regarding the citizenship, immigration status and Social Security number of persons who are living in an applicant’s household, but who are not applying for benefits or who are not eligible for benefits.
These inquiries may have the unintended effect of discouraging some families from applying for and receiving benefits to which they or their children are entitled. The guidance recommends that states review their application forms and eligibility determination processes and make changes, if necessary.
While states are often required to establish the citizenship and immigration status of applicants, they may not require applicants to provide information about any other person’s citizenship or immigration status. For example, if a child is applying for Medicaid or the State Children’s Health Insurance Program (SCHIP), the state may not require disclosure of the citizenship or immigration status of non-applicant parents or other household or family members.
In addition, states are reminded that the Privacy Act of 1974 prevents states from requiring that an individual disclose his or her Social Security number (SSN) unless there is a specific federal statute that mandates such disclosure. Thus, while states may require that applicants for Medicaid, TANF and food stamps provide their SSNs, states may violate the Privacy Act when they require non-applicants living in the household or family unit to provide their SSN’s. States always may request individuals to voluntarily provide their SSNs as long as states make clear that disclosure is voluntary and explain what will be done with SSN’s that are disclosed.:
Question: Are there any civil rights issues involved in how states ask about citizenship, immigration status and SSNs when determining eligibility for public benefits?
Answer: Potentially yes. The answer depends on whether such inquiries have a discriminatory effect on people whose rights are protected by Title VI. Title VI of the Civil Rights Act of 1964, and its implementing regulation, prohibit entities receiving federal funds, such as states, from discriminating against any person on the basis of that person’s race, color, or national origin. Title VI covers both intentional acts and facially neutral policies and actions that have an adverse impact based on race, color or national origin.
For example, some application forms require an applicant (or someone acting on the applicant’s behalf) to certify under penalty of perjury that each person in the applicant’s household is a U.S. citizen or immigrant in
Question: What are the rules for Medicaid, including a Medicaid expansion under SCHIP, with respect to questions regarding citizenship, immigration status, and social security number information on state applications?
Answer: Citizenship/Immigration Status: States must require disclosure of the citizenship or immigration status only of the person or persons for whom Medicaid benefits are being sought (i.e., the applicant(s)). (Social Security Act ß 1137(d); 42 U.S.C. ß 1320b-7(d)).
For example, if a parent applies for Medicaid on behalf of his or her child, the citizenship or immigration status of the parent (or other household members) is irrelevant to the child’s eligibility, and the state may not require that parents disclose the information. States may not deny benefits because the applicant (or a person acting on behalf of the applicant) did not certify or document the citizenship or immigration status of persons in the applicant’s household for whom benefits are not being sought.
These same rules apply to Medicaid expansion programs under SCHIP. Social Security Numbers (SSNs): States must require the disclosure of SSNs only for applicants and recipients of Medicaid benefits (Social Security Act ß 1137(a); 42 U.S.C. ß 1320b-7(a)). If an SSN has not been issued, states must assist individuals to apply for one. (42 C.F.R. ß 435.910(e)). States can ask non-applicants for an SSN but only if they clearly indicate that provision of this information is voluntary, and if they indicate how the information will be used.
States may not deny benefits because the applicant did not provide the SSNs of persons who are neither applicants for nor recipients of Medicaid or SCHIP (Medicaid expansion program) benefits.
3. The Multiethnic Placement Act and Inter-ethnic Placement Provisions (MEPA)
The Multiethnic Placement Act (MEPA) and Inter-ethnic Adoption Provisions (IEP) were implemented in the spirit of removing barriers to permanency for the vast number of children in the child protective system, and to ensure that adoption and foster placements are not delayed or denied based on race, color or national origin. The purposes of MEPA-IEP are to:
• reduce the length of time that children
wait to be adopted,
4. Racial/Ethnic Health Disparities
In January 2000, the U.S. Department of Health and Human Services (DHHS) released Healthy People 2010, our nation’s health goals for this decade. One of two major themes of Healthy People 2010 is the elimination of racial and ethnic disparities in health status that have been documented repeatedly over the years across a broad range of medical conditions despite improvements in health for the nation as a whole.
Despite notable progress in the overall health of the nation, there are continuing disparities in illness and death experienced by members of racial and ethnic groups, compared to the U.S. population as a whole. The demographic changes that are anticipated over the next decade magnify the importance of addressing disparities in health status, which is a primary goal of Healthy People 2010. A national focus on disparities in health status that addresses both medical and social bases (including potential discrimination and civil rights issues) for disparities is important as major changes unfold in the diversity of the population and in the way in which health care is delivered and financed.
OCR’s jurisdictional basis for working with states, localities, and providers with respect to potential race and national origin discrimination is Title VI of the Civil Rights Act of 1964. Recipients of HHS federal financial assistance must ensure that policies and procedures do not exclude or have the effect of excluding or limiting the participation of beneficiaries in their programs on the basis of race, color or national origin.
The following HHS resources highlight OCR’s focus to address disparities in health-care:
• Healthy People 2010. Describes this national health promotion and disease prevention initiative created by a broad coalition of experts from many sectors to improve the health of all Americans. Healthy People is designed to achieve two overarching goals, one of which is to eliminate health disparities among different segments of the population. It contains 467 objectives in 28 focus areas. Healthy People 2010 provides background information on the initiative; the complete text (online and searchable), Healthy People 2010: Understanding and improving health (2nd ed.) (2000); data and statistics (see below); a list of the Healthy People partners and related sites; and other Healthy People publications. It is coordinated by the U.S. Office of Disease Prevention and Health Promotion.
• Healthfinder® just for you. Points to health education resources about a wide range of health concerns based on age, gender, race, and ethnic origin. healthfinder® is a service of the U.S. Department of Health and Human Services (DHHS)
• National Institutes of Health (NIH): Addressing Health Disparities. Describes the NIH plan for tackling (via research) disparities experienced by racial and ethnic minority populations in the following six areas: infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection/AIDS, and immunizations. Links to the strategic plans and resources on health disparities for all NIH institutes and centers.
• Office of Minority Health (OMH). Links to program information, conferences, publications, data, federal clearinghouses, and other resources about minority health issues including racial and ethnic health disparities. OMH was created by the U.S. Department of Health and Human Services to advise on public health issues affecting American Indians and Alaska Natives, Asian Americans, Native Hawaiians and Other Pacific Islanders, African Americans, and Hispanics.
• Center for Disease Control Launches Spanish-Language Website The CDC has launched its Spanish-language website at http://www.cdc.gov/spanish. The general public, policy makers, media and public health professionals around the world rely on CDC’s website for credible information to enhance health decisions. Now, Spanish speakers will have access to that resource. The Spanish language website is not a translation of the English language website (at www.cdc.gov) but is tailored to Hispanic and Latino populations.
The web site will grow as CDC plans to translate more of its articles, press releases and other documents into Spanish and make them available at this site. Currently, Spanish speakers will find information that CDC has developed on a wide variety of health topics from asthma to diabetes.
In addition, Spanish speakers will find gateways to health information produced by our sister Federal agencies.
5. Persons With Disabilities
Approximately 54 million people almost one in five Americans have developmental, physical or mental disabilities. Their needs and abilities vary widely. But for all of these individuals, disability can affect every aspect of their lives with health, emotional, social and financial consequences.
There are several laws designed to tear down the barriers to equality facing people with disabilities.
• Olmstead/New Freedom Initiative. In February 2001, the President announced the New Freedom Initiative, a government-wide framework for helping provide people with disabilities with the tools they need to fully access and participate in their communities.
The initiative’s proposals that involve the Department of Health and Human Services (HHS) include: promoting full access to community life through swift implementation of the Olmstead Supreme Court decision; integrating Americans with disabilities into the workforce through swift implementation of the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA); and the creation of the National Commission on Mental Health. Details of the New Freedom Initiative are available at http://www.whitehouse.gov/news/freedominitiative/ freedominitiative.html and at http://www.hhs.gov/newfreedom.
• Section 504 of the Rehabilitation Act of 1973 is a national law that protects qualified individuals from discrimination based on their disability. The nondiscrimination requirements of the law apply to employers and organizations that receive financial assistance from any Federal department or agency, including the U.S. Department of Health and Human Services (DHHS).
These organizations and employers include many hospitals, nursing homes, mental health centers and human service programs. Section 504 forbids organizations and employers from excluding or denying individuals with disabilities an equal opportunity to receive program benefits and services. It defines the rights of individuals with disabilities to participate in, and have access to, program benefits and services. Section 504 protects qualified individuals with disabilities.
Under this law, individuals with disabilities are defined as persons with a physical or mental impairment which substantially limits one or more major life activities. People who have a history of, or who are regarded as having a physical or mental impairment that substantially limits one or more major life activities, are also covered.
Major life activities include caring for one’s self, walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning. Some examples of impairments which may substantially limit major life activities, even with the help of medication or aids/devices, are: AIDS, alcoholism, blindness or visual impairment, cancer, deafness or hearing impairment, diabetes, drug addiction, heart disease, and mental illness.
• The Americans with Disabilities Act (ADA) of 1990 provides comprehensive civil rights protections to individuals with disabilities in the areas of employment, state and local government services, public accommodations, transportation, and telecommunications.
The ADA protects qualified individuals with disabilities. An individual with a disability is a person who has a physical or mental impairment that substantially limits major life activities; has a record of such an impairment; or is regarded as having such an impairment.
Major life activities means functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working. Under the ADA, a qualified individual with a disability is an individual with a disability who meets the essential eligibility requirements for receipt of services or participation in programs or activities.
Whether a particular condition constitutes a disability within the meaning of the ADA requires a case-by-case determination. Physical or mental impairments include, but are not limited to: visual, speech, and hearing impairments; mental retardation, emotional illness, and specific learning disabilities; cerebral palsy; epilepsy; muscular dystrophy; multiple sclerosis; orthopedic conditions; cancer; heart disease; diabetes; and contagious and non-contagious diseases such as tuberculosis and HIV disease (whether symptomatic or asymptomatic).
The Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (DHHS) enforces Federal laws that prohibit discrimination by health care and human service providers that receive funds from DHHS. One such law is the Age Discrimination Act of 1975.
The Age Discrimination Act of 1975 is a national law that prohibits discrimination on the basis of age in programs or activities receiving Federal financial assistance. The Age Discrimination Act applies to persons of all ages. It does not cover employment discrimination. (The Age Discrimination in Employment Act applies specifically to employment practices and programs, both in the public and private sectors, and applies only to persons over age 40).
Complaints under the Age Discrimination in Employment Act should be sent to: U.S. Equal Employment Opportunity Commission, Washington, D.C. 20506.
7. Medical Privacy
The privacy provisions of the federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), apply to health information created or maintained by health care providers who engage in certain electronic transactions, health plans, and health care clearinghouses. The Department of Health and Human Services (HHS) has issued the regulation,”Standards for Privacy of Individually Identifiable Health Information,” applicable to entities covered by HIPAA. The Office for Civil Rights (OCR) is the Departmental component responsible for implementing and enforcing the privacy regulation.
The federal privacy regulation empowers patients by guaranteeing them access to their medical records, giving them more control over how their protected health information is used and disclosed, and providing a clear avenue of recourse if their medical privacy is compromised. The rule will protect medical records and other personal health information maintained by certain health care providers, hospitals, health plans, health insurers and health care clearinghouses.
• Patients must give specific
authorization before entities covered by this regulation could use or
disclose protected information in most non-routine circumstances - such
as releasing information to an employer or for use in marketing
How To File A Discrimination Complaint With The Office For Civil Rights
If you believe that you have been discriminated against on the basis of race, color, national origin, disability, age, and in some cases sex or religion, by an entity (recipient) that receives Federal financial assistance from the U. S. Department of Health and Human Services (DHHS), you may file a complaint with the Office for Civil Rights (OCR).
The complaint should be filed within 180 days from the date of the alleged discriminatory act. OCR may extend the 180-day period if you can show “good cause.”
Include the following information in your written complaint, or request a Discrimination Complaint Form from an OCR Regional or Headquarters office:
• Your name, address and telephone
number. You must sign your name. (If you are filing a complaint on
someone’s behalf, include your name, address, telephone number, and
statement of your relationship to the individual—e.g., spouse, attorney,
For information on how to file a
complaint of discrimination, or to obtain information of a civil rights
nature, please contact us.