On May 6, 2025, the U.S. Department of Health and Human Services (HHS) issued a Dear Colleague Letter on Nondiscrimination Requirements for Medical Schools on the Basis of Race, Color, and National Origin pursuant to Students for Fair Admissions, Inc. v. President & Fellows of Harvard College. The letter addresses “federal prohibitions on explicit and pretextual race-based discrimination” under Title VI of the Civil Rights Act of 1964, Section 1557 of the Affordable Care Act and the Equal Protection Clause of the U.S. Constitution. The letter makes clear that enforcing nondiscrimination requirements at medical schools is a priority for HHS, including addressing explicit and pretextual race-based discrimination.
Mirroring guidance previously provided by other federal agencies, the letter states that “federal law prohibits covered entities from relying on race or racial stereotypes in decisions pertaining to admissions, hiring, promotion, compensation, financial aid, scholarships, prizes, administrative support, discipline, housing, graduation ceremonies, and the like.” The letter also addresses programs that appear facially neutral but serve as proxies for race-based decision-making, including medical schools that use personal statements, writing samples or extracurricular activities as a means to infer an applicant’s race. HHS’s position is that programs that “confer advantages or impose burdens based on generalizations associated with racial identity” can create a hostile environment in violation of federal law.
HHS notes that “public-facing online materials from several medical schools raise questions about whether the principles set forth in SFFA have been fully integrated into current admissions policies.”
HHS advises medical schools to:
- ensure that all policies, procedures and practices are fully consistent with applicable federal civil rights laws;
- discontinue the use of any criteria, tools or processes that serve as substitutions for race or are intended to advance race-based decision-making; and
- cease reliance on third-party contractors, clearinghouses or data aggregators that engage in prohibited uses of race.
HHS indicates it will prioritize investigations of medical schools that use race as part of their application or employment processes; require prospective students, employees or faculty to submit DEI or diversity statements in connection with hiring or promotion; or lack clear policies demonstrating compliance with SFFA. Medical schools found to be out of compliance with the federal civil rights laws are subject to investigation by HHS, which may impact eligibility for federal funding.
McGuireWoods recommends that medical schools conduct or continue to conduct a privileged review of their web materials, application materials, scholarship programs, clerkships, and other programs and initiatives to ensure compliance with Title VI. For questions about this process contact the authors of this article.
HHS takes the position that because Section 1557 incorporates Title VI, discriminatory practices that violate Title VI also violate the Affordable Care Act. Affordable Care Act compliance for educational institutions, including designating a Section 1557 coordinator, will be discussed during McGuireWoods’ June 3, 2025, Hot Topics in Higher Education Webinar.