Health Equity blog

In FY 2016, the Tenth Revision to the International Statistical Classification of Diseases and Related Health Problems introduced Z codes to document social determinants of health (SDOH) among patients seeking care. Based upon a study of commercial claims processed from 2016 to 2022 and published in the May 2025 edition of Health Affairs, it is clear that the codes are not used with any consistency across patient demographics and adoption of Z codes in general continues lagging.

On May 22, the House of Representatives narrowly passed its budget reconciliation legislation seeking to extend tax cuts and other parts of the Administration’s agenda while significantly cutting government spending on other programs, specifically Medicaid. Medicaid provisions in the bill include new work requirements, limiting states’ use of the provider tax under the Medicaid program, increasing Medicaid eligibility verification and reducing the Federal Medical Assistance Percentage (FMAP) for Medicaid Expansion states who use their program to provide health care for undocumented immigrants, among other things. The Congressional Budget Office (CBO) estimates that the House bill would reduce Medicaid spending by $625 billion and that 7.6 million people in the United States will lose health insurance by 2034. While Senate Republican leadership has made a goal of passing its version of legislation by July 4, there are already Republican challenges to the House-passed bill as well as Senate parliamentary requirements that could significantly alter provisions.

A newly issued report from the Center for Healthcare Quality & Payment Reform (CHQPR) claims that, just since 2020, over 100 rural hospitals have stopped delivering babies or will by the end of this year. Moreover, a mere 42% of all rural hospitals still offer labor and delivery services. These figures are daunting for pregnant women because the implications include longer commutes to find a hospital that provides these vital services, which can be life-threatening for medically complicated pregnancies. The CHQPR report does, however, outline possible actions that can be taken to curb this alarming trend.

In accordance with the Trump Administration’s February 2025 memorandum – Radical Transparency About Wasteful Spending – the Department of Health and Human Services (HHS) has been terminating numerous grants. HHS maintains the Tracking Accountability in Government Grants System (TAGGS), a database of grants awarded by HHS’s twelve operating divisions, including the NIH, and the running list of terminated grants can be found here.

The original study conducted on cancer antigen 125 (CA-125) in 1981 involved mostly White women as subjects, which established the thresholds applied universally to all women for early detection of ovarian cancer. A March 2025 study published in JAMA Network Open, however, concluded that the healthy levels of CA-125 in Black women were 10 to 37% lower, and for Native American women up to 20% lower, compared to White women. Consequently, these diverse populations have experienced delays in treatment and poorer health outcomes due to underdiagnosis based upon CA-125 test results.

As part of his “Make America Healthy Again” (MAHA) platform, HHS Secretary Robert F Kennedy, Jr announced his initial plans to reduce perceived waste and inefficiencies within the Department, which includes an additional reduction in personnel by 10,000 FTEs, purportedly saving taxpayers $1.8 billion annually. In addition, the previous 28 divisions within HHS will be reduced to 15 newly restructured and repurposed divisions. The plans establish the Administration for a Healthy America (AHA), which will combine multiple agencies including the Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute for Occupational Safety and Health (NIOSH) as one entity.  Meanwhile, a MAHA caucus has been established in both the House and Senate to align legislative efforts with the Secretary’s societal health goals, including improving access to primary care and nutritious food sources.

On April 10, the Centers for Medicare and Medicaid Services (CMS) sent a letter to all state Medicaid directors, informing them that CMS would no longer be approving proposed 1115 Medicaid waivers’ inclusion of programs with a non-medical purpose, such as housing, nutrition, and transportation assistance. CMS’s rationale is that such programs have historically not otherwise been covered under Medicaid and should not be subject to federal matching funds as part of new Section 1115 applications (nor will existing ones be allowed as part of any renewals).

Another JAMA Network Open study published earlier this month determined that individual social risk screenings are more accurate in assessing and adequately determining patients’ needs for outpatient services compared to the traditional local community level screenings that rely upon the federal Neighborhood Deprivation Index (NDI). Individual self-reported social risk screening requires patients to indicate their specific social needs, such as financial assistance, food, housing, or transportation. Although these individualized screenings may be more productive, they are nonetheless hampered by dependency upon a greater concentration of resources, as well as patients’ reluctance to participate due to the perceived stigma, among other challenges.

On March 15, President Trump signed into law the Full- Year Continuing Appropriations and Extensions Act, 2025, narrowly averting a partial federal government shutdown. Buried within this Act are certain provisions that impact health care delivery. Section 2207 extends Medicare flexibilities for telehealth services provided by rural health clinics and Federally Qualified Health Centers (FQHCs) – previously extended in the Consolidated Appropriations Act, 2023 – through September 30, 2025. Similarly, Section 2208 extends the Acute Hospital Care at Home initiative, as currently authorized under Centers for Medicare and Medicaid Services (CMS) waivers and flexibilities, through September 30 as well.

In accordance with President Trump’s Executive Order 14173, which is aimed at eradicating discrimination and restoring merit-based opportunities, HHS’s Office of Civil Rights (OCR) is investigating four medical schools and hospitals that receive HHS funding. In response to alleged violations of Title VI of the Civil Rights Act of 1964, OCR is assessing whether these medical schools and hospitals are operating medical education, training, or scholarship programs that discriminate on the basis of race, color, national origin, or sex. Executive Order 14173 directs federal agencies to enforce long-standing civil rights laws and “to combat illegal private sector DEI preferences, mandates, policies, programs, and activities.”