Fact Sheet: Advancing Health Equity Across HHS

This National Minority Health Month, the U.S. Department of Health and Human Services (HHS) is proud to highlight some of its efforts to advance health equity for all, including people of color and others who have been historically underserved, under-resourced, marginalized, and adversely affected by persistent poverty and inequality.

Advancing health equity and addressing health disparities is a top priority of President Biden and Secretary Becerra. Across HHS, achieving equity is a department-wide effort. Some of HHS’s most significant health equity accomplishments are highlighted below. HHS commits to building on this progress and continuing to address and close health disparities for all Americans.

Lowering Health Care Costs

Thanks to President Biden’s signature of the lower cost prescription drug law — the bipartisan Inflation Reduction Act —Americans enrolled in Medicare are saving money on their prescription drugs.

• Capping the Cost of Insulin to $35 for a Month’s Supply and Making Recommended Vaccines Free: The Inflation Reduction Act signed by President Biden is already saving Medicare enrollees money by capping out-of-pocket spending at $35 per month’s supply of each insulin product covered under Medicare. The Inflation Reduction Act also eliminated out-of-pocket costs for vaccines covered under Medicare Part D that are recommended by the Advisory Committee on Immunization Practices (ACIP). These benefits extend to all Medicare participants enrolled in the Part D program, including the estimated 5.8 million Black, 5.3 million Hispanic/Latino, and 2.1 million Asian Americans enrolled.
• Negotiating the Price of Prescription Drugs: For the first time in history, Medicare is now able to directly negotiate the price of some of the costliest prescription drugs covered under Medicare. HHS, through the Centers for Medicare & Medicaid Services (CMS), last year announced the first 10 drugs covered under Medicare Part D selected for negotiation. The negotiations with the drug companies of these 10 selected drugs are underway, and any negotiated Maximum Fair Prices will become effective beginning in 2026. Some of these drugs treat serious conditions such as blood clots, diabetes, cardiovascular diseases, heart failure, autoimmune conditions, and chronic kidney disease, many conditions which disproportionately impact Black, Hispanic/Latino, American Indian, and Alaska Native communities.
• Removing Barriers to Vaccination: The Administration for Community Living (ACL) awarded two grants totaling $125 million to rapidly increase the number of older adults and people with disabilities who have received the updated COVID-19 vaccine and annual flu vaccine. These programs host community vaccine clinics, provide in-home vaccinations, provide transportation to vaccination sites, conduct outreach and education to older adults as well as people with disabilities, and more.
• Providing Access to COVID-19 Treatment: The HHS Administration for Strategic Preparedness and Response (ASPR) is providing Paxlovid at no cost to patients with public insurance through 2024, and to uninsured patients through 2028 or until the U.S. government supply is depleted. These actions help address the disparate impact of COVID-19 in American Indian, Alaska Native, and Black American communities as well as other racial and ethnic minorities.

Record Expansion of Health Care Coverage

A historic 21.3 million Americans have selected an Affordable Care Act Insurance Marketplace plan during the 2024 Open Enrollment period.

• Quality Affordable Health Care: HHS has continued its commitment to making health insurance available and affordable to everyone. Thanks to the Inflation Reduction Act and the American Rescue Plan, 4 out of 5 people on the Marketplace can find coverage for $10/month or less after financial subsidies.
• Reaching All Americans: For this past enrollment cycle, the Administration issued almost $100 million in Navigator Awards, allowing organizations to hire staff who are trained to help consumers find affordable, comprehensive health coverage. Navigators, as they are known, have been key to reaching consumers where they are, and helping them enroll in quality health insurance plans in every Marketplace state. While data disaggregated by race for the 2024 Open Enrollment period will be available in the coming weeks, we know, based on the historic number of enrollees and the work Navigators have done at the community and neighborhood level, that many of the Americans who have enrolled are American Indian and Alaska Native, racial/ethnic minorities and/or come from rural communities.
• Increasing Health Coverage in Rural Communities: Medicaid expansion has played a key role in expanding health coverage in rural communities. Rural communities rely on the Marketplace, Medicaid, and Medicare; 1 in 3 rural adults are enrolled in Medicare, 1 in 6 are enrolled in state Medicaid programs, and 1 in 10 are covered by Marketplace coverage. In 2019, rural uninsured rates were nearly twice as high in non-expansion states as expansion states.

Improving Health Outcomes

HHS is committed to addressing health disparities and advancing health equity by expanding access to care, improving health care quality, and supporting health care providers who serve populations who are at increased risk for poor health outcomes.

• Quality Affordable Maternal Health Care: The United States has the highest maternal mortality rate among developed nations, and Native Hawaiian and other Pacific Islanders, Black, American Indian and Alaska Native persons have the highest rates of pregnancy-related deaths. HHS is committed to improving maternal health and advancing health equity.
  • Medicaid and the Children’s Health Insurance Program (CHIP) finance more than 4 in 10 births in the U.S. and are an important source of maternal health care. HHS has encouraged states to take up a new option to extend postpartum coverage under Medicaid and CHIP from 60 days to 12 months. Thus far, 45 states plus Washington, D.C. and the U.S. Virgin Islands have expanded postpartum coverage.
  • President Biden signed legislation that increased funding for the Tribal Maternal, Infant, and Early Childhood Home Visiting Program from $12 million in 2022 to $30 million in 2023. This major expansion brings evidence-based home visiting services to more tribal communities.
  • In September 2023, the Health Resources and Services Administration (HRSA) announced nearly $90 million in awards to increase access to care in maternity care deserts, address maternal depression, and grow the maternal health workforce.
  • In 2023, HHS reached a milestone of more than 1,900 birthing facilities participating in the Alliance for Innovation on Maternal Health, a program under which hospitals and other facilities adopt proven strategies to increase safe births and reduce negative birth outcomes.
  • HHS has invested in and made HHS’s new maternity care quality data easily accessible through the Care Compare “Birthing-Friendly” designation, a consumer-friendly icon noting that a hospital or health system has demonstrated a commitment to improving maternity care quality.
  • In 2023, HHS reached a milestone of supporting 36 Perinatal Quality Collaboratives (PQCs). PQCs are state or multi-state networks of multidisciplinary teams working to improve population-level maternal and infant healthcare and outcomes statewide. PQCs advance evidence-based clinical practices and processes using quality improvement principles and convene and collaborate with diverse representatives (clinical teams, experts, partners, patients, families) to rapidly improve perinatal healthcare and outcomes statewide and reduce disparities in healthcare and outcomes between subpopulations within a state.
  • The Housing and Services Partnership Accelerator, launched in collaboration with the U.S. Department of Housing and Urban Development (HUD), supports eight states and the District of Columbia, to develop or expand housing-related supports and services for people who are Medicaid-eligible, including people with disabilities, and older adults who are experiencing or are at risk of experiencing homelessness.
  • Under the Medicare inpatient hospital payment system, CMS has recognized the higher costs that hospitals incur for treating people who are experiencing homelessness, when hospitals report social determinants of health codes on claims. CMS also finalized new Medicare care navigation codes, which describe services intended for people who have an unmet social need (which can include homelessness) that affects the diagnosis and treatment of medical problems, in the Calendar Year 2024 Medicare Physician Fee Schedule.
  • Through the HRSA Ryan White HIV/AIDS Program (RWHAP), nearly 9 out 10 of people with HIV who receive RWHAP medical services reached viral suppression in 2022. This means that they cannot transmit HIV to their partners and these individuals can live longer, healthier lives. The percentage of Black/African American clients, Hispanic/Latino clients, and youth and young adult clients aged 13-24 who received care through the RWHAP and reached viral suppression all far exceeded overall national viral suppression rates.
  • Due, in part, to the efforts of multiple HHS agencies to expand pre-exposure prophylaxis (PrEP) awareness, availability, and provider capacity, preliminary data indicate that in 2022, 36% of the 1.2 million people who could benefit from PrEP were prescribed it, compared to 23% in 2019, the year that the Ending the HIV Epidemic in the U.S. (EHE) Initiative was announced.
  • Centers for Disease Control and Prevention’s (CDC's) EHE-funded programs have provided more than 44,000 PrEP prescriptions and connected with over 260 Syringe Services Programs (SSPs), 60% of which provide mobile services.
  • In 2020 and 2021, HRSA’s RWHAP served nearly 38,000 clients new to care or re-engaged in care in support of the EHE. In the first 2 years of EHE, more than 20% of people in EHE jurisdictions who were undiagnosed or not previously in care were served by HRSA-funded EHE providers.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) funded three Minority HIV/AIDS Fund: Integrated Behavioral Health and HIV Care for Unsheltered Populations Pilot Project grants in fiscal year 2023 for a total of $1,997,536. The program provides comprehensive healthcare and addresses disparities facing medically underserved people experiencing unsheltered homelessness through the delivery of portable clinical care delivered outside that is focused on the integration of behavioral health and HIV treatment and prevention services.
  • From data collection and research to the approval of new therapies, HHS is answering the call, and supporting programs critical for helping people with SCD live healthier lives. Ongoing efforts include expanding the Sickle Cell Data Collection program; releasing a Sickle Cell Disease Action Plan; continuing research on treatment including through the Cure Sickle Cell Initiative; supporting programs that span across the SCD system of care, such as newborn screening, diagnosis, access to treatments; and considering testing approaches to improve access to innovative treatments and reduce program expenditures starting with SCD under the Cell and Gene Therapy Access model recently announced by the CMS Innovation Center.

  Bolstering Rural Health Care Providers

  HHS is taking actions to improve health outcomes in rural communities by focusing on access to care.

  • Grants to Rural Hospitals and Communities to Provide Health Care Services: HHS has several grant opportunities to support rural communities, including $28 million to provide direct health services and expand infrastructure and $16 million to provide technical assistance to rural hospitals facing financial distress. In 2023, 60 rural hospitals received technical assistance to maintain financial viability and ensure continued access to care. The HHS Office of Climate Change and Health Equity is also helping rural facilities access funding made available in the Inflation Reduction Act for energy efficiency, renewable energy, and resilience.
  • Increase Resident Training Opportunities in Hospitals Serving Underserved Communities: CMS is allocating 1,000 new Medicare-funded physician residency training slots to qualifying hospitals authorized by the Consolidated Appropriations Act, 2021, phasing in 200 slots per year over five years and prioritizing hospitals with training programs in geographic areas demonstrating the greatest need for additional providers. CMS is also working to implement the allocation of an additional 200 slots for Fiscal Year 2026, which includes at least 100 slots specifically for psychiatry and psychiatry subspecialty residencies, as enacted in the Consolidated Appropriations Act, 2023. HHS expects to provide additional outreach and technical assistance to rural hospitals to encourage them to apply for these new residency positions. HHS, through HRSA, also awarded over $11 million through the Rural Residency Planning and Development Program (RRPD) to help establish new rural residency programs. Accredited RRPD-funded programs are already training over 300 resident physicians in family medicine, internal medicine, psychiatry, and general surgery.
  • Improving Access to Treatment for Opioid Use Disorders: Access to opioid use treatment services in rural areas is vital.
    • In March 2024, HHS announced the launch of nearly $50 million for HRSA’s Rural Opioid Treatment and Recovery Initiative and released the initiative’s funding application. Funding will support establishing and expanding comprehensive substance use disorder treatment and recovery services in rural areas, including by increasing access to medications for opioid use disorder, such as buprenorphine. Opioid use disorder is particularly concerning in rural communities and accessing treatment can be challenging due to geographic isolation, transportation barriers, and limited substance use disorder providers.
    • SAMHSA has also updated the 42 CFR part 8 federal regulations that set the standard for opioid treatment program (OTP) accreditation, certification and treatment to expand access to care by reducing barriers to entry, allowing for the use of telehealth among OTPs, and by codifying mobile treatment units. This helps to overcome geographic disparities in access to care, particularly among rural populations.
    • The National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) initiative received a total of $636 million in Congressionally appropriated funds in Fiscal Year 2023 in part to provide awards to advance research to mitigate disparities in health care for pain and associated mental health impact. The program aims to develop and implement evidence-based, non-opioid interventions that enhance access to pain care by addressing stigma, bias, and discrimination at the levels of individuals, providers, communities, and systems.
    • To address this issue, CMS released guidance clarifying that Medicaid and CHIP coverage and payment of interprofessional consultation is permissible, even when the beneficiary is not present, as long as the consultation is for the direct benefit of the beneficiary.
    • SAMHSA’s Rural Emergency Medical Services (EMS) Training grant program offers the opportunities for rural EMS organization to recruit and train EMS personnel in rural areas with a particular focus on addressing substance use disorders and co-occurring disorders substance use and mental disorders.

    Bolstering Tribal Health Care Providers

    HHS is taking actions to improve health outcomes in Tribal communities and help Tribal health care providers stay open.

    • Improving Tribal Water and Sanitation Systems: Thanks to $3.5 billion from President Biden’s Bipartisan Infrastructure Law (BIL), from 2022 through 2026, the Indian Health Service (IHS) will provide 71,000 American Indian and Alaska Native homes with critical services like water wells, onsite wastewater disposal systems, and connections to community water supply and wastewater disposal systems. By December 31, 2023, the IHS had exceeded its original goal by completing the Construction Document Phase for 124 projects.
    • Expanding Access to Telehealth Services: IHS Telebehavioral Health Center of Excellence (TBHCE) has expanded telebehavioral health services markedly since the pandemic. In partnership with Tribes, counseling and prescribing services are now available to thousands of patients for whom lack of transportation may have been a barrier to care. Over 8,000 patients have received child, adult, and addiction psychiatry and counseling. According to early estimates, the availability of telehealth behavioral health services has resulted in over $1 million in avoided travel costs and over 25,000 hours of work or school not missed.
    • Supplemental Payments for Indian Health Service and Tribal Hospitals: This supplemental payment from CMS supports stability in uncompensated care payments and mitigates long-term financial disruption for these hospitals.
    • Strengthening Public Health Systems and Services in Indian Country: As of October 2023, CDC has awarded nearly $26 million to 26 federally recognized American Indian and Alaska Native Tribes and regional Tribally designated organizations to improve Tribal public health infrastructure and services to Tribal communities through a new 5-year cooperative agreement. This program will strengthen the quality, performance, and infrastructure of tribal public health systems, including workforce, data and information systems, and programs and services. This funding will help improve public health outcomes and lessen health inequities in Indian Country.

    Advancing Civil Rights and Nondiscrimination in Health Care

    HHS enforces federal civil rights laws that protect the rights of individuals and entities from unlawful discrimination on the basis of race, color, national origin, disability, age, or sex in covered health and human services.

    • Expanding Language Access and Culturally Appropriate Care: HHS’s Office for Civil Rights (OCR) led efforts to develop the HHS Language Access Plan, which sets forth practical guidance, best practices, and action steps for the agency to increase language access. Many offices and divisions are already taking important steps to make their materials available to people with Limited English Proficiency (LEP) and people with disabilities.
      • CMS has reinstated requirements that Medicare Advantage (MA) and Part D plans include a multi-language insert to inform beneficiaries of the availability of free language and translation services and that MA plan provider directories include a provider’s cultural and linguistic capabilities.
      • SAMHSA’s 988 Suicide & Crisis Lifeline has expanded to include Spanish text and chat services in addition to existing phone capabilities. 988 also now includes American Sign Language (ASL) and videophone services for people who are deaf or hard of hearing.
      • The SAMHSA Disaster Distress Helpline (DDH) is the first national hotline dedicated to providing year-round disaster crisis counseling. This toll-free, multilingual, crisis support service is available 24/7 to through call, text, and ASL videophone to all residents in the U.S. and its territories who are experiencing emotional distress related to natural or human-caused disasters through call, text, videophone.
      • The National Institutes of Health-funded Qungasvik Toolbox study, developed through a collaboration with Yup’ik communities and researchers at the University of Alaska, examined how tapping into a community’s culture can reduce youth substance misuse and suicidal ideation and behavior(s). Findings showed that the Qungasvik intervention was effective in reducing co-occurring youth alcohol misuse and suicide risk, and ultimately, alcohol use disorder and death by suicide.
      • The HHS Office for Civil Rights (OCR) proposed to update and clarify critical provisions that help persons with disabilities access health 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 nondiscrimination laws and adds specifics in new areas to prevent and respond to discrimination on the basis of disability in covered programs.
      • The Administration for Community Living (ACL) updated its regulations implementing the Older Americans Act (OAA) for the first time in more than 30 years to better reflect the needs of today’s older adults. The OAA requires the aging services network, which provides the services funded by ACL under the OAA, to focus on older adults, elders, and family caregivers who have the greatest economic and social need, with particular attention to people with lower incomes and older adults from minority populations, older adults living in rural communities, with limited English proficiency, or at risk of institutional care. Consistent with the OAA statutory language, the updated OAA regulations align the definition of greatest social need with Executive Order 13985.
      • OCR proposed to amend Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy regulations to 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.
      • In 2023, Title X clinics provided family planning services to 2.6 million clients, almost 1 million more clients than in the previous year. The Title X program remains a critical safety net for people in all 50 states, Washington, D.C., and eight U.S. Territories and Freely Associated States. Title X clinics provide services for free or on a reduced scale for clients, 31% of whom are uninsured and 84% of whom have family incomes below 250% of the Federal Poverty Level. Clients can receive a wide range of voluntary, client-centered family planning and related preventive services through a network of over 4,000 Title X clinics.
      • OCR has proposed to update the regulations implementing Section 1557 of the Affordable Care Act (ACA) to restore and strengthen nondiscrimination protections for LGBTQI+ people 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 status in the provision of health services.
      • OCR has also released a proposed update to the HHS Grants Rule that protects LGBTQI+ people from discrimination in certain covered human services programs by clarifying the prohibition on discrimination on the basis of sex includes discrimination on the basis of sexual orientation and gender identity. The proposed HHS Grants Rule would confirm nondiscrimination protections in covered HHS programs as well as services and grants that provide aid.
      • SAMHSA’s 988 Suicide & Crisis Lifeline has expanded to include specialized call, text, and chat services for LGBTQI+ youth and young adults wanting to connect with counselors specifically focused on meeting their needs.
      • In 2024, SAMHSA announced four awards totaling $5.1 million for Family Counseling and Support for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex+ Youth and their Families. These grants are in addition to $1.7 million in grant funding previously awarded in 2023 to four other recipients. All eight awardees will be engaging LGBTQI+ youth and their families to prevent risk of health conditions, including behavioral health conditions and promote well-being for LGBTQI+ youth by establishing family counseling and support programs and training providers on family counseling and support interventions tailored for LGBTQI+ families.
      • The NIH National Institute on Minority Health and Health Disparities (NIMHD) has recently awarded grants to six institutions through the John Lewis NIMHD Research Endowment Program. Totaling $60 million, these esteemed grants will create institutional endowments that propel the development and expansion of research capacity at recipient institutions and support research education for students from diverse backgrounds, including those from underrepresented groups.
      • Since 2011, the Centers for Disease Control and Prevention (CDC) has been partnering with institutions to offer fellowships that introduce undergraduate and graduate students to public health topics including minority health and health equity, supporting their career development, and preparing the future public health workforce through the John R. Lewis Undergraduate Public Health Scholars (Lewis Scholars) Program and the James A Ferguson Emerging Infectious Diseases (Ferguson) Graduate Fellowship.

      Advancing Data Equity

      Health equity data can help care teams identify and address health disparities, which leads to improved health outcomes at an individual and population level. Data can make it possible to streamline social care referrals and improve care delivery, person-centered decision-making, research, population health improvement, and public health. The privacy interests of American Indian and Alaska Native populations should be respected when working with Tribal communities.

      • Standardizing Social Determinant of Health and Sexual Orientation and Gender Identity (SOGI) Data: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Core Data for Interoperability (USCDI) is a standardized set of health data elements for nationwide, interoperable health information exchange. Starting in 2026, many certified health information technology (IT) products will need to support new data elements that promote health equity including SOGI data and Social Determinant of Health assessment data, for instance, assessments of housing and food insecurity risk.
      • HHS-Wide Sexual Orientation and Gender Identity (SOGI) Data Action Plan: The SOGI Data Action Plan seeks to improve data equity in public health and human services.
        • As part of the SOGI Data Action plan, CDC added SOGI data to HIV, Sexually Transmitted Infections (STI), and mpox surveillance and added a question about experiences with LGBTQI+ discrimination to the Youth Risk Behavior Survey.
        • CDC’s National Center for Health Statistics added sexual orientation questions to the National Health Interview Survey in 2013, and gender identity questions in 2022. Additionally, the National Health and Nutrition Examination Survey, as well as the National Survey of Family Growth, include measures related to sexual orientation.
        • IHS has published a circular adding SOGI to their patient records.
        • CMS added SOGI questions to all HealthCare.gov Marketplace applications and proposed adding SOGI to the Medicare Part C and Part D enrollment forms. CMS also issued an Information Bulletin to states allowing them to add SOGI questions to state Medicaid and Children’s Health Insurance Program (CHIP) applications.
        • The Administration for Children and Families Office on Trafficking in Persons has embedded SOGI measures in all victim assistance and training information requests.
        • SAMHSA added SOGI questions in its National Survey on Drug Use and Health.
        • ACL has begun to add SOGI questions to its Information Collection Requests for its aging and disability programs.

        We invite you to learn more by reading each division’s factsheet: