Several hours after taking the oath of office, President Joe Biden signed an executive order directing the federal government to advance racial equity and support for people of color and others who have been historically underserved, marginalized, and harmed by persistent poverty and inequality. The order affected more than 90 federal agencies, including the Department of Health and Human Services (HHS) and the Department of Housing and Urban Development (HUD). Each agency then assessed whether its programs and policies perpetuate systemic barriers to opportunities and benefits for people of color and other underserved groups, and whether new policies, regulations, or guidance documents will be needed to advance equity. These assessments informed the development of Equity Action Plans, released by the White House last month, that outline concrete strategies and commitments to address systemic barriers across the federal government.

Equitable Data

The executive order established an Interagency Working Group on Equitable Data tasked with identifying inadequacies in existing federal data collection policies, programs, and infrastructure and recommending ways to expand data available for measuring equity. Last month, the working group — informed by academic researchers, community leaders, advocates, and experts — released recommendations for advancing the use of equitable data. The working group recommended that the federal government adopt the following practices to “allow for rigorous assessment of the extent to which government programs and policies yield consistently fair, just, and impartial treatment of all individuals”:

• Make it the norm to break down data into detailed segments, such as race and ethnicity, while protecting people’s privacy. This would entail revising the Office of Management and Budget Statistical Policy Directive 15: Race and Ethnic Standards for Federal Statistics and Administrative Reporting (PDF); generating statistical estimates in detailed segments; and establishing best practices for tracking sexual orientation, gender identity, disability, and rural location.
• Establish and use data sharing partnerships for equity assessments to expand protected access to existing data across federal programs.
• Build capacity for robust equity assessment by investing in the necessary human capital and by using initiatives funded by the American Rescue Plan Act of 2021 and Infrastructure Investments and Jobs Act to promote the use of processes for assessing equity.
• Promote diverse partnerships with state and local governments and researchers by increasing intergovernmental data sharing and by expanding opportunities for historically underrepresented scholars.
• Increase transparency about progress made in serving marginalized populations and building user-friendly data access tools.

HHS Equity Action Plan

The HHS Equity Action Plan (PDF) highlights ways in which HHS is advancing health equity, including policy actions, indicators to track progress, and accountability measures such as oversight and transparency. Here are examples of the breadth and depth of HHS actions, both planned and underway:

• Civil rights protection and language access. HHS plans to improve language access services for those with limited English proficiency to ensure meaningful access to information, services, and benefits from Medicare, Medicaid, and other programs. HHS will focus on web pages, public outreach materials, telephonic interpreter services, and other improvements. HHS is expected to reverse Trump administration changes to implementation of the Affordable Care Act that significantly curtailed nondiscrimination protections in health care, including for those with limited English.
• Acquisitions. HHS plans to reduce barriers faced by “small disadvantaged businesses” (e.g., minority-owned businesses) when applying for HHS procurement opportunities. HHS plans to offer training to help those businesses navigate agency requirements, points of contact, and available resources. HHS will post upcoming contracting opportunities on centralized procurement forecasting systems to maximize the available time for proposal development.
• Grantmaking. To increase diversity among grantees, HHS will implement internal guidance on how to incorporate equity considerations into notice of funding opportunities. HHS plans to provide technical assistance to potential applicants to ensure federal funding reaches eligible organizations in historically underserved communities.
• Capacity building. HHS plans to conduct equity assessments in its programs, including Medicare and Medicaid. The department will determine whether access to federal benefits is equitable and will develop strategies for addressing identified barriers. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued a request for information on enrollees’ access to care and coverage within Medicaid and the Children’s Health Insurance Program (CHIP). CMS intends to use the comments it received to help develop a comprehensive strategy for more equitable access for Medicaid and CHIP populations. CMS also sought comments on ways to advance health equity through quality reporting programs tied to Medicare payments. For example, the FY 2023 Hospital Inpatient Prospective Payment System proposed rule seeks comments on ways to better measure and analyze health care disparities in quality programs.
• Maternal mortality. The American Rescue Plan Act of 2021 gives states a new option to extend postpartum coverage under Medicaid and CHIP from 60 days to 12 months. In December 2021, CMS issued guidance to state health officials (PDF) on implementation of this new state option. California adopted the postpartum care expansion for Medi-Cal and Medi-Cal Access Program beneficiaries, effective April 1, 2022. The state option is currently limited to a five-year period that ends in 2027. In the FY 2023 prospective payment proposed rule, CMS put forth a “Birthing-Friendly” designation awarded to hospitals that would capture the quality and safety of maternity care. Through the HHS Racial Equity in Postpartum Care Challenge, the Office on Women’s Health, in partnership with CMS, is seeking innovative ways to improve postpartum care for Black and American Indian and Alaska Native people enrolled in Medicaid or CHIP. The competition emphasizes follow-up care for conditions associated with morbidity and mortality, including diabetes, postpartum depression, postpartum anxiety, hypertension, and substance use disorders. The challenge will conclude in 2023. Finally, the Health Resources and Services Administration announced the availability of $4.5 million for hiring, training, certifying, and compensating community-based doulas through the Healthy Start Initiative.

Housing and Urban Development Plans

The HUD Equity Action Plan (PDF) acknowledges that “federal housing policies were implemented and operated for decades in a manner that enables discriminatory practices against people of color and members of underserved communities.” The plan is part of the administration’s vision for reversing the harm caused by previous policies and prioritizing equity in HUD programs. This work has begun, and the plan outlines the strategies proposed as it continues.

Over the last year, HUD has adopted approaches to improve equity and racial justice in housing, including:

• Preventing housing discrimination against LGBTQ+ people
• Increasing access for people with limited English
• Promoting equity in home appraisal
• Enhancing fair housing enforcement
• Expanding capital for the development of affordable rental housing
• Increasing housing counseling services
• Promoting equity in competitive grants
• Improving housing outcomes for underserved people experiencing homelessness

HUD proposes additional strategies in these areas:

Procurement. The complexity of the federal procurement system has long been a barrier to socially disadvantaged businesses. As a result, they have been limited in their ability to access federal housing contract opportunities that can support community economic growth and wealth building. HUD aims to remove these barriers through effective outreach and support for small minority businesses.

Housing and civil rights. The mission of HUD’s civil rights unit, the Office of Fair Housing and Equal Opportunity, is to eliminate housing and lending discrimination against people of color and other vulnerable populations. HUD proposes to increase the office’s staffing to better enforce civil rights and fair housing laws in these areas:

• Home ownership. HUD is working to eliminate the gap in racial home ownership by increasing access to financing and by removing bias, including the undervaluation of properties owned by people of color, including Black people, American Indians, and Alaska Natives — a disparity that has long plagued the appraisal system. Underserved groups are far less likely than White households to own a home. There are layers of discriminatory practices that have led to this being the case. HUD’s equity plan lays out a range of strategies to address this through a variety of programs as well as through partnerships with federal and nonfederal organizations.
• Homelessness. “Black people, other people of color, people with disabilities, and LGBTQ+-identified people continue to have longer periods of homelessness, longer times to be housed, and higher rates of return to homelessness,” according to HUD’s equity plan and the 2020 Annual Homeless Assessment Report (AHAR) to Congress (PDF). The equity plan outlines 10 strategies HUD plans to adopt to tackle these disparities. Many build on work within the department’s Office of Special Needs Assistance Programs to advance equity in homeless assistance. These include efforts to increase racial equity within the “coordinated entry systems” that have been developed nationwide. These systems assess a homeless person’s housing needs in a relatively quick and streamlined way, prioritize who will receive assistance, and match them with the best housing options. A demonstration project is underway to identify racial bias in existing processes and to pilot equitable processes. HUD is developing racial equity toolkits to help communities understand and address the overrepresentation of people of color within the homeless community.

Next Steps

The Equity Action Plans provide ways to hold the Biden-Harris administration accountable for its promise to advance equity and racial justice. Insight into the ongoing federal strategies offers policymakers and state and local stakeholders the opportunity to coordinate and collaborate. Increased federal investments will be necessary to sustain implementation of the Equity Action Plans.

Alyssa Llamas

Alyssa Llamas is a policy director at the Wynne Health Group. She has a diverse background in health policy and public health, including experience in government, research, and nonprofit settings. Llamas previously worked at the US Centers for Disease Control and Prevention.

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