Discrimination based on an individual’s race, color or national origin is prohibited

Under Section 1557, a covered entity may not:

• Segregate, delay or deny services or benefits based on an individual’s race, color or national origin. For example,
  • A covered entity may not assign patients to patient rooms based on race.
  • A covered entity may not require a mother to disclose her citizenship or immigration status when she applies for health services for her eligible child.
• Delay or deny effective language assistance services to individuals with limited English proficiency (LEP).
  • The term “national origin” includes, but is not limited to, an individual’s, or his or her ancestor’s, place of origin (such as a country), or physical, cultural, or linguistic characteristics of a national origin group.

Section 1557 protects individuals in the United States, whether lawfully or not, who experience discrimination based on any of Section 1557’s prohibited bases.

Discrimination based on an individual’s sex is prohibited

Under Section 1557:

• Providers cannot deny or limit sex-specific health services based solely on the fact that the gender identity or gender recorded for an individual does not align with the sex of individuals who usually receive those types of sex-specific services (e.g., denying a transgender  male a pap smear or denying a transgender woman a prostate exam).
• Sex specific programs are allowed only if a covered entity can show an exceedingly persuasive justification for the program. That means the sex­ specific nature of the program must be substantially related to an important health-related or scientific objective.
  • For example, a breast cancer program cannot refuse to treat men with breast cancer solely because its female patients would feel uncomfortable.

Discrimination based on an individual’s age is prohibited

Under Section 1557:

• A covered entity may not exclude, deny or limit benefits and services based on an individuals’ age (e.g., a physician’s practice may not deny a 62- year-old man health services because it only accepts patients under age 60).
• A covered entity may base its actions on age when it is a factor necessary to the normal operation, or achievement of a statutory objective of a program. Therefore, this standard does not apply to any age distinction that is authorized under Federal, State, or local law. For example, age rating in premium rates within a 3:1 ratio in Marketplace 5M plans would not violate Section 1557 because it is permitted under the ACA.
• A covered entity may also provide different treatment based on age when the treatment is justified by scientific or medical evidence (e.g., a physician may decide to deny a mammogram to a woman under a certain age because recent medical studies have suggested that mammograms may be more harmful than helpful to young women), or based on a specialty (e.g., pediatricians are not required to treat adults and gerontologists not required to treat children).

Discrimination based on an individual’s disability is prohibited

Under Section 1557:

• An individual may not be excluded or denied benefits or services because of a disability.
• Covered entities must take the following steps, unless they would result in an undue financial burden or would fundamentally alter the program:
  • Make reasonable changes to policies, procedures and practices where necessary to provide equal access for individuals with disabilities. For example, a clinic must modify its “no pets” policy to permit an individual with a disability to be accompanied by a service animal. Additionally, a clinic must allow an individual with an anxiety disorder to wait for an appointment in a separate, quiet room if the individual is unable to wait in the patient waiting area because of anxiety.
  • Make all health programs and activities provided electronically (e.g., through online appointment systems, electronic billing, information kiosks, etc.) accessible to individuals with disabilities. For example, a doctor’s office that requires patients to make appointments only online must modify its procedures so that a person with a disability who cannot use the required method can still make an appointment.
  • Ensure newly constructed and altered facilities are physically accessible to individuals with disabilities.
  • Provide effective communication with individuals with disabilities, including patients and their companions.

Discrimination in health insurance or other health coverage is prohibited

Under Section 1557:

• Covered entities may not, in providing or administering health­ related insurance or other health-related coverage, discriminate on the basis of race, color, national origin, sex, age, or disability.
• Covered entities may not, on any of the above covered bases:
  • Deny, cancel, limit or refuse to issue or renew a health insurance plan or other health coverage.
  • Deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage.
  • Use discriminatory marketing practices or benefit designs (e.g., plan covers treatment for eating disorders in women but not men).
• Categorical exclusions or limitations in coverage for all health care services related to gender transition are prohibited.
• Section 1557 does not prohibit covered entities from determining whether a particular health service is medically necessary or otherwise meets applicable