OCR Dear Colleague Letter on Civil Rights Protections Against Antisemitic Discrimination

September 3, 2026

Re: Combating Discrimination Rooted in Antisemitism in HHS-Funded Programs and Activities

Dear Colleagues:

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR), issues this letter to clarify how Federal civil rights laws apply when antisemitic discrimination1 arises in HHS-funded programs and activities.2 Recipients of HHS Federal financial assistance must administer their programs and activities without discrimination based on race, color, or national origin.  That obligation applies pursuant to Title VI of the Civil Rights Act of 1964 (Title VI) and, in covered health programs and activities, Section 1557 of the Affordable Care Act (Section 1557).

Title VI provides that “[n]o person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”3  Section 1557 separately prohibits discrimination in covered health programs and activities on grounds prohibited by Title VI and other enumerated civil rights statutes.4  Antisemitic conduct may violate Title VI or Section 1557 when the facts establish discrimination on a protected ground, including actual or perceived Jewish ancestry or ethnic characteristics, Israeli national origin, or another protected ground.5 

This letter is addressed to recipients of HHS funding, including hospitals, nursing facilities, medical schools, residency and fellowship programs, research institutions, human services providers, and colleges and universities that receive HHS Federal financial assistance.6  It is also issued consistent with Executive Order 14188, which declares it “the policy of the United States to combat anti-Semitism vigorously.”7

I.        LEGAL FRAMEWORK

HHS’s Title VI regulations prohibit recipients, “directly or through contractual or other arrangements,” from denying services, providing services differently, segregating or separately treating individuals, restricting program benefits, or treating individuals differently in eligibility or participation because of race, color, or national origin.8  In other words, a recipient may not accomplish through contractors, subrecipients, affiliates, staffing arrangements, or clinical sites what Title VI forbids it to accomplish directly.  Additionally, Title VI coverage attaches to “all of the operations of” covered entities identified in 42 U.S.C. § 2000d-4a, when the statutory conditions are met, not merely to the particular office or department through which HHS funds are received.9

Section 1557 separately provides that an individual may not, on a ground prohibited under Title VI (and other enumerated civil rights statutes), “be excluded from participation in, be denied the benefits of, or be subjected to discrimination under” any health program or activity, any part of which receives Federal financial assistance.10  OCR enforces Section 1557’s core protections, including those prohibiting race, color, and national origin discrimination in covered health programs and activities.11  For the race, color, and national origin claims addressed in this letter, OCR’s Section 1557 analysis tracks the Title VI protected-ground framework.12

Executive Order 13899 directs agencies to consider the working definition of antisemitism adopted by the International Holocaust Remembrance Alliance (IHRA) and IHRA’s contemporary examples “to the extent that any examples might be useful as evidence of discriminatory intent,” while directing that agencies “not diminish or infringe upon any right protected under Federal law or under the First Amendment.”13

It also states that “individuals who face discrimination on the basis of race, color, or national origin do not lose protection under Title VI for also being a member of a group that shares common religious practices,” and “[d]iscrimination against Jews may give rise to a Title VI violation when the discrimination is based on an individual’s race, color, or national origin.”14  That approach is consistent with Supreme Court precedent recognizing discrimination based on “ancestry or ethnic characteristics” under other anti-discrimination statutes.15

Accordingly, OCR evaluates allegations involving conduct described as antisemitic under Title VI and Section 1557, as applicable, by investigating whether the evidence shows intentional discrimination based on actual or perceived Jewish ancestry or ethnic characteristics, Israeli national origin, or another protected ground.  

II.       ANTISEMITISM IN HEALTH CARE SETTINGS

1. Patient and Resident Care

A covered entity may not deny, delay, downgrade, segregate, or otherwise differentiate care or services because of actual or perceived Jewish ancestry or ethnic characteristics, Israeli national origin, or any other protected ground.  The prohibition reaches both clinical and administrative functions, including access to care, treatment, staffing, security, discharge planning, and grievance processing.16  Such conduct may be unlawful if undertaken because of a protected ground rather than individualized clinical, safety, or operational judgments applied without discrimination.  OCR evaluates such matters based on the totality of the evidence, including whether the asserted clinical, safety, infection-control, or operational rationale is consistently applied and reflects individualized judgment rather than differential treatment because of a protected ground.17

Examples may include assigning patients, delaying treatment, imposing additional security or identification requirements, or modifying communication or grievance handling because a patient, family member, or clinician is, or is perceived to be, Jewish or Israeli.18  Comparable concerns may arise where Jewish or Israeli patients are treated as collectively responsible for geopolitical events in a way that affects care, dignity, access, or services.  By contrast, individualized clinical, safety, or operational rules applied without regard to protected status are generally not prohibited.

2. Medical Education and Clinical Training

HHS funding recipients operating health professions schools and training programs may not intentionally discriminate on the basis of race, color, or national origin in the administration of their covered operations.  Examples of covered operations and benefits may include admissions, financial aid, grading, clerkships, patient care, research, conference participation, and official ceremonies.19

OCR has taken several significant actions to combat antisemitism in HHS-funded programs, with a particular focus on HHS-funded educational institutions (e.g., medical schools) entrusted with training the next generation of health care professionals.  OCR announced multiple Title VI compliance reviews of medical schools to investigate allegations of antisemitism; issued guidance to medical schools regarding prohibited race-based admissions practices under Title VI and Section 1557; and issued Title VI Notices of Violation to Columbia University and Harvard University concerning their responses to antisemitic harassment of Jewish and Israeli students.20

3. Physicians, Nurses, Faculty, Staff, and Trainees (Program Participants)

OCR’s Title VI jurisdiction over employment practices is limited by statute; under 42 U.S.C. § 2000d-3, Title VI reaches a recipient’s employment practices only where a primary objective of the Federal financial assistance is to provide employment.  This letter addresses physicians, nurses, faculty, staff, and trainees principally as participants in HHS-funded health, education, training, research, or workforce programs; it does not assert general OCR jurisdiction over employment discrimination.21

II.     RELIGIOUS NONDISCRIMINATION

Distinct from Title VI, OCR also enforces multiple Federal religious nondiscrimination provisions in grant and block grant programs that prohibit discrimination against individuals on the basis of religion.22  One such provision OCR enforces is the religious nondiscrimination component of the Medicare and Medicaid visitation requirements applicable to participating hospitals, critical access hospitals, and long-term care facilities.  Those regulations forbid covered facilities from “restrict[ing], limit[ing], or otherwise deny[ing] visitation privileges” on the basis of religion, among other grounds.23  Covered facilities must administer visitation without discrimination against Jewish patients and residents and their visitors (e.g., rabbis, chaplains, family members, caregivers) subject only to clinically necessary or otherwise reasonable restrictions.  

Examples of potential violations include permitting clergy visits for only certain faiths, or generally, while excluding rabbis; imposing special screening on visibly Jewish visitors because of religious affiliation; allowing use of non-kosher technology to facilitate visitation but not allowing kosher technology for the same purposes; and, where national origin is implicated under Title VI, denying Israeli family members access available to others.24

IV.     HARASSMENT AND RETALIATION

1. Harassment Legal Standard

Harassment may constitute unlawful discrimination under Title VI or Section 1557 where, under the totality of the circumstances, conduct based at least in part on race, color, or national origin denies or limits equal access to a covered program or benefit.25  OCR will consider all relevant and permissible legal theories supported by the facts.  A recipient’s intentional conduct that creates, fosters, or perpetuates a protected-status hostile environment may itself constitute discrimination under Title VI or Section 1557.26

Where the alleged violation concerns a recipient’s response to known protected-status harassment, deliberate indifference is one available basis for finding noncompliance.27  HHS has applied deliberate indifference principles in recent Title VI enforcement matters.28 

Under the Davis-derived deliberate indifference framework, a recipient may be deliberately indifferent to a hostile environment when the harassment is sufficiently severe, pervasive, and objectively offensive to deprive the affected person of equal access to a covered program or benefit; the recipient has actual knowledge of the harassment; the recipient has the authority to exercise substantial control over the harasser and the context in which the harassment occurs; and the recipient’s response is clearly unreasonable in light of known circumstances.29  OCR may also consider whether the recipient delayed its response without justification, offered no meaningful response, failed to follow its own policies, treated comparable misconduct or protected-status harassment inconsistently, failed to restore equal access, or continued using the same “remedial” measures after learning that they were ineffective.

It is important to note that, in administrative enforcement, OCR is not limited to the conjunctive Davis private-damages formulation (“severe, pervasive, and objectively offensive”).  Depending on the applicable theory and facts, protected-status harassment that is sufficiently severe or pervasive to deny or limit equal access may establish a hostile environment under Title VI or Section 1557.30  Whether that hostile environment results in recipient noncompliance depends on the applicable legal theory and the recipient’s own conduct or response.

2. Recent Enforcement Examples

OCR’s 2025 Columbia and Harvard31 Title VI Notices of Violation, and DOJ’s 2025 findings concerning the University of California, Los Angeles, applied deliberate indifference principles to antisemitic hostile environment allegations.  These enforcement actions, relying on this judicially implied heightened standard, illustrate the kinds of reporting, remediation, discipline, vandalism response, policy enforcement, and access-restoration failures that may be relevant to OCR’s analysis when the recipient’s response (or non-response) to a hostile antisemitic environment has been particularly egregious.32

3. Examples in Health Care and Clinical Education Settings

In health care and clinical education settings, harassment concerns may arise in clinical, residential, educational, research, digital, ceremonial, and other spaces controlled by the recipient.  A recipient with actual knowledge of protected-status harassment within its control should take appropriate steps within its authority before the conduct becomes threatening or otherwise escalates into obstruction, denial of care, exclusion from training, or other interference with access to covered programs or services.

4. Retaliation

Retaliation is independently prohibited.  HHS’s Title VI regulations provide that no recipient or other person “shall intimidate, threaten, coerce, or discriminate against any individual” to interfere with that individual’s rights under Title VI or because the individual “has made a complaint, testified, assisted, or participated in any manner in an investigation, proceeding or hearing” under the regulation.33  Subject to the jurisdictional limits described above, examples of retaliatory actions may include adverse evaluations, removal from rotations or clinical teams, denial of covered research or training opportunities, professionalism charges, or threats against individuals who report discrimination or participate in an OCR investigation.

V.      EXAMPLES OF COMPLIANCE MEASURES

Recipients should ensure that their personnel, policies, and procedures can identify and address intentional discrimination, protected-status harassment, and retaliation.  Examples of appropriate, fact-specific measures may include clear nondiscrimination policies; accessible reporting channels for patients, residents, visitors, clinical staff, and other program participants; training for responsible personnel; civil rights-compliant contracts and affiliation agreements; documentation of complaints, responsive actions taken, restoration of access, and follow-up to assess effectiveness; and measures reasonably calculated to prevent recurrence where appropriate.34

CONCLUSION

Antisemitic discrimination has no place in Federally funded health care, medical education, clinical training, research, higher education, or human services.  Jewish and Israeli patients, residents, visitors, students, faculty, and health care professionals are entitled to equal access, dignity, and individualized treatment in HHS-funded programs.  A recipient that accepts HHS funds must administer its covered programs without intentional discrimination based on race, color, or national origin; must not engage in intentional conduct that creates or fosters a hostile environment; and must not retaliate against those who invoke the protection of the law.

Any person who believes that a recipient of HHS funding has engaged in antisemitic discrimination, or related conduct in violation of Title VI or Section 1557, may file a complaint with OCR.  Complaints generally must be filed in writing within 180 days of the alleged discrimination, identify the entity involved, and describe the acts or omissions at issue.35

Where the facts establish a violation of Federal civil rights law within OCR’s jurisdiction, including discrimination rooted in antisemitism in HHS-funded programs and activities, OCR will use every available enforcement tool, as appropriate, to secure compliance.

Sincerely,

 /s/

Paula M. Stannard
Director, Office for Civil Rights
U.S. Department of Health and Human Services