Given the potential consequences for noncompliance with these laws—including loss of federal funding—medical schools should evaluate how they can demonstrate compliance with federal law as articulated in the DCL.

On May 6, 2025, the Department of Health and Human Services (HHS) issued a Dear Colleague Letter (DCL) providing guidance on how medical schools can comply with implementation of the U.S. Supreme Court case Students for Fair Admissions, Inc. v. President & Fellows of Harvard College (SFFA), 600 U.S. 181 (2023). That case held that considering race as a factor in college or university admissions violates the equal protection clause of the U.S. Constitution and Title VI of the Civil Rights Act of 1964. The four-page DCL interprets the relevant holdings from SFFA and related Supreme Court cases and the related requirements for medical schools from the equal protection clause, Title VI and Section 1557 of the Affordable Care Act. It then provides guidance for how medical schools can comply with HHS’ interpretation of those requirements, as well as how HHS intends to enforce them. Given the potential consequences for noncompliance with these laws—including loss of federal funding—medical schools should evaluate how they can demonstrate compliance with federal law as articulated in the DCL.

As discussed in the DCL, educational institutions that receive federal funds must comply with federal nondiscrimination law. This includes medical schools, which receive such funds through HHS. The key nondiscrimination requirement comes from the incorporation of the equal protection clause found in Title VI, which says:

No person in the United States shall, on the basis 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.

Section 1557 has a similar provision, which provides that:

[A]n individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 [and certain other laws], 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 is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments).

Section 1557 gives HHS authority to issue regulations implementing this requirement.

SFFA assessed the legality of admissions policies at Harvard and the University of North Carolina (UNC). Harvard’s policy allowed applicant screeners to consider an applicant’s race when evaluating their candidacy for admission. It also included a final step in the class-selection process where the applicant-selection committee would accept or reject applicants based on race to establish a certain percentage of racial minorities in the class year. UNC’s policy required applicant screeners to consider race and ethnicity as a factor when evaluating an applicant’s candidacy, with race being a potential “plus.” It also allowed the committee that made final acceptance decisions to consider applicants’ race.

The Supreme Court in SFFA held that both institutions’ policies violated the equal protection clause and Title VI because (1) the policies’ justifications were insufficiently compelling or measurable to satisfy the Supreme Court’s “strict scrutiny” standard for using race in admissions, (2) under the policies, race could be a negative and could operate as a stereotype, and (3) the policies (which sought to achieve greater racial diversity) had no discrete end point. Accordingly, under SFFA, institutions that receive federal funds—including medical schools—may not consider race in admissions decisions in the ways that Harvard and UNC did.

The DCL cites concerns that some medical schools are not in compliance with SFFA’s holding. Stating that “while some programs may appear facially neutral, closer scrutiny may reveal that they function as proxies for race-based decision-making, which is inconsistent with federal law,” the DCL notes that “medical institutions may not use application materials—such as personal statements, writing samples, or extracurricular activities—as a means to infer a student’s race and then apply differential treatment based on that inference.” The DCL also refers to public-facing materials on some medical school websites that indicate the SFFA holding may not be fully integrated into admissions policies at those schools. The DCL references a 2024 incident where a whistleblower alleged that a medical school was admitting unqualified applicants based on race. Accordingly, the DCL gives the following examples of policies that HHS would consider to be violations of the same:

• Any reliance on race or racial stereotypes in decisions pertaining to admissions, hiring, promotion, compensation, financial aid, scholarships, prizes, administrative support, discipline, housing, graduation ceremonies and the like.
• Using application materials (such as personal statements, writing samples or extracurricular activities) as a means to infer a student’s race and then apply differential treatment based on that inference.
• Conferring advantages or imposing burdens through diversity and inclusion programs on students based on generalizations associated with racial identity.

HHS would treat these as violations regardless of whether they are applied on an individualized basis or as part of a broader institutional framework.

The DCL accordingly advises medical schools to:

1. Ensure that all policies, procedures and practices are fully consistent with applicable federal civil rights law;
2. Discontinue the use of any criteria, tools or processes that serve as substitutes for race or are intended to advance race-based decision-making; and
3. Cease reliance on third-party contractors, clearinghouses or data aggregators that engage in prohibited uses of race.

The DCL advises that noncompliant medical schools may be subject to investigation, measures to ensure compliance or restrictions on eligibility for federal funding. HHS will prioritize investigating those medical schools that:

1. Use race as part of their application or employment processes;
2. Require prospective students, employees or faculty to submit diversity statements in connection with hiring or promotion; or
3. Lack clear policies demonstrating compliance with SFFA.

The DCL also provides guidance on filing discrimination complaints with HHS’s Office for Civil Rights.

The DCL is the latest in a series of nondiscrimination actions taken by HHS under the second Trump administration. On February 3, 2025, the Department of Justice announced the formation of a multiagency task force to combat antisemitism, consisting of the Department of Justice, the Department of Education and HHS. As part of its involvement in that task force and other initiatives, HHS has initiated:

• Reviews of the University of Washington as well as four unnamed medical schools following reports of antisemitic incidents;
• Reviews of both Harvard and Columbia University’s federal contracts and grants following alleged inaction in the face of ongoing antisemitic incidents (which were followed by cancellations of $2.2 billion in multiyear grants and $60 million in multiyear contracts for Harvard and $400 million of such grants and contracts for Columbia University);
• An investigation into an unnamed California medical school for discriminatory race-based admissions policies; and
• An investigation into Harvard and the Harvard Law Review based on reports of race-based discrimination concerning the operations of the latter.

While the DCL does not create any new requirements, it does affirm HHS’ intention to enforce the requirements of SFFA and related laws—an intention confirmed by the above actions. The above investigations also demonstrate that HHS’s discrimination investigations may be broader than just admissions policies.

Given the gravity of consequences for discrimination violations and the active investigations by HHS into allegations of such violations, medical schools should evaluate how they can demonstrate that their relevant policies and procedures comply with SFFA and other federal nondiscrimination laws as well as HHS’ interpretation of the same.

For More Information

If you have any questions about this Alert, please contact Katherine D. Brodie, Erin M. Duffy, Taylor Hertzler, any of the attorneys in our Health Law Practice Group, any of the attorneys in our Higher Education Group or the attorney in the firm with whom you are regularly in contact.

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