Enforcement Success Stories Involving Race, Color, and National Origin

Summary of Selected OCR Compliance Reviews and Complaint Investigations

• University of Pittsburgh Medical Center (UPMC) (PA) – OCR Region III reached a voluntary resolution agreement with UPMC, prior to conducting a full-scale investigation.  The complaint alleged that UPMC violated Title VI of the Civil Rights Act of 1964, when it closed one of its affiliated hospitals located in a small, predominately African American community near Pittsburgh, Pennsylvania.  UPMC maintains that it closed the facility due to millions of dollars in financial losses as well as underutilization by the community.  In order to ensure that the hospital’s closure does not have a disparate impact on the predominantly minority community, UPMC agreed to subsidize expanded hours and services at a federally qualified health center; provide door to door transportation for residents to three outpatient facilities in a neighboring community; and provide door to door service to another UPMC affiliated hospital.  UPMC also agreed to conduct six health-screening programs throughout the year as well as a diabetes-screening program twice a year; designate an ombudsperson to help individuals navigate the UPMC health care system; and provide outreach to faith-based health ministries in the community. Read the Voluntary Compliance Agreement | Read the HHS Press Release (Spanish)

• Wisconsin Department of Children and Families (DCF) – Under a voluntary compliance agreement between the Wisconsin Department of Children and Families (DCF) and OCR, DCF will ensure that when Wisconsin families seek income assistance and help finding employment, they will have an equal opportunity to participate in the Temporary Assistance for Needy Families (TANF) program.  Pursuant to Title VI of the Civil Rights Act of 1964 (Title VI), DCF will ensure that sanctions (i.e., reductions in income assistance) are not applied to TANF participants in a discriminatory manner based on race, color, or national origin (including limited English proficiency).  Under Section 504 of the Rehabilitation Act of 1973 (Section 504), and Title II of the Americans with Disabilities Act of 1990 (ADA), DCF will screen and assess TANF applicants and participants to ensure that qualified individuals with disabilities receive reasonable accommodations, which may include job training and supports for a longer time period than what is typically afforded, sign language interpreters, or in-depth services from the Wisconsin Division of Vocational Rehabilitation. Read the Voluntary Compliance Agreement | Read the “Wisconsin Works (W-2) Sanctions Study” | Read the HHS Press Release

• University of New Mexico Hospital(NM) – OCR Region VI resolved a complaint which alleged that a 75-year old Spanish speaking individual was not provided with language assistance services during her medical appointment.  In response to OCR’s investigation and provision of technical assistance, the Hospital, a 431-bed facility, took corrective action to improve its language services program, including:  (1) revising its limited English proficiency (LEP) policy; (2) coordinating its interpreters and translations through a recently established Interpreter Language Service Department; (3) mandating a staff training program on language services; (4) implementing an interpreter qualification testing and training program; (5) posting signs informing the public of the availability of language assistance services; (6) translating over 900 forms and vital documents; and (7) conducting periodic reviews and monitoring to ensure the effectiveness of language services for LEP persons.  These corrective actions also were implemented at the Hospital’s off-site clinics, as well as the UNM Children’s Hospital, UNM Children’s Psychiatric Center, UNM Adult Psychiatric Center, the UNM Cancer Center, and the UNM Carrie Tingley Hospital.  Read the Letter of Finding

• Montgomery County Department of Social Services (NY) – OCR Region II secured a Voluntary Resolution Agreement with the Montgomery County Department of Social Services (MCDSS) in New York to ensure that people with limited English proficiency (LEP)–those who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English–will have improved access to Medicaid and other social services programs. The MCDSS provides or administers a wide range of publicly funded social services and cash assistance programs, including Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program), Medicaid, emergency assistance, general relief, adult protective services, and personal care services.  Its programs reach approximately 28,000 people. Under the agreement, MCDSS voluntarily committed to take steps to ensure that the language access needs of its LEP clients are properly assessed and that competent language access services are provided to clients for the full range of services, including home visits and evaluations.  MCDSS agreed to provide timely language assistance services to ensure effective communication during home visits and evaluations; to notify LEP clients of the availability of free language assistance; to use family or friends as interpreters only when specifically requested by the client after the client has been notified of the option for free language assistance; to translate vital program documents; and to establish mandatory staff training on their obligations under Title VI.  Read the Resolution Agreement | Read the HHS Press Release  (Spanish - PDF)

• South Carolina Department of Social Services (DSS) - U.S. Department of Health and Human Services Administration for Children and Families (ACF) entered into a comprehensive compliance agreement that ensures that DSS will not delay or deny the placement of children into foster or adoptive homes, or deny parents the opportunity to foster or adopt children, due to race, color or national origin. This compliance agreement follows OCR’s issuance of a violation Letter of Findings in October of 2005 and ACF’s issuance of a Penalty Letter which adopted OCR’s violation findings and found that South Carolina had violated its title IV-E State plan requirements in February of 2006.

 The agreement resolves a review conducted by OCR to determine whether DSS was in compliance with Title VI and Section 1808(c). In its violation Letter of Findings, OCR found six systemic violations and numerous individual violations where the state agency denied parents the opportunity to adopt a child based not on whether the parents could best meet the needs of the child but on whether the parents shared the same race, color or national origin as the child.

An instance involving an African-American couple illustrates the harm that can result from this kind of discrimination. The couple had fostered almost two dozen children and had adopted two young African-American girls through DSS. DSS had consistently given the couple outstanding reviews based on their participation in the foster and adoptive care programs. Then the couple attempted to adopt a Hispanic child whom they were fostering, but they were denied the opportunity even to be considered. Instead, the child was placed with a Hispanic family after a search in which numerous other non-Latino families also were denied consideration, based on the desire to match the child only with parents of "Hispanic/Latin background." When it was learned that the couple might appeal the placement decision, some DSS staff tried to discourage the couple from appealing and to remove the child from their care before they would have the right to appeal. The couple appealed nonetheless.

On appeal, the placement decision was overturned and DSS was directed to give the couple "first consideration" as the child’s adoptive parent. However, DSS then delayed processing the adoption.

OCR found that in this situation and other similar situations, DSS adoption staff made many assumptions about race and the needs of children based on race. DSS assumed that children would have specific needs based on their race or national origin, and they similarly assumed that parents of the same race or national origin would be better equipped to address those needs. However, these conclusions were not based on actual need or abilities but just presumptions based on the race or national origin of the children and parents involved. Similarly, DSS staff assumed that parents would feel uncomfortable adopting a child if the child’s skin color did not closely match the parents. However, these conclusions also were not based on actual conversations with parents, but solely on presumptions about the color of their skin. In focusing on race, color and national origin, the adoption staff lost sight of the goal, which is supported by federal law -- to find parents best able to meet the needs of a child and provide a loving home. Moreover, delays and denials of placements in order to find same race, color or national origin placements, ultimately delay placement of needy children and force them to stay in foster care longer than they would otherwise.

The compliance agreement includes provisions that will address these and other problems. Under the agreement, DSS commits to take the following actions:

• • Notify program applicants and participants of their rights under Title VI and Section 1808 in a variety of forms and at various application and participation stages of DSS programs;
  • Send a notice to all persons who attempted to adopt a child during the period that DSS was found to be in violation;
  • Send a notice to all persons whose individual rights were found to have been violated, notifying them of the substance of OCR’s findings and of their rights under Title VI and Section 1808;
  • Provide Title VI and Section 1808 training to all adoption and foster care staff;
  • Revise all policies and procedures, forms and brochures to ensure they comply with Title VI and Section 1808 and that they do not deter people from trying to adopt or foster children of a different race, color or national origin;
  • Adopt policies and procedures that allow staff to consider the race, color or national origin of parents only if this addresses a need of a child documented by a licensed professional; and
  • Revise all family assessments in which families who were willing to adopt a child of another race or national origin were subjected to additional scrutiny.

Read the Closure Letter | Read the Resolution Agreement | Read ACF Penalty Letter

• Florida Department of Children and Families Voluntary Compliance Agreement [PDF] The Florida Department of Children and Families ("DCF") is the state agency responsible for administering eligibility determinations for Temporary Assistance to Needy Families, Medicaid, and the State Children's Health Insurance Program. In early 2000, OCR received a complaint alleging that eligible Hispanic applicants were being discriminated against at the DCF office located in Okeechobee County. The complaint alleged that DCF employees requested extra documentation from Latino applicants, asked unnecessary questions about the citizenship status of non-applicant household members, threatened to report Hispanic household members to the INS, and denied benefits to eligible persons if their household included other persons unwilling or unable to provide Social Security Numbers ("SSNs") or documentation proving citizenship or immigration status.

OCR's investigation found existing and/or potential violations of Title VI of the Civil Rights Act of 1964. DCF responded with a letter of intent to voluntarily comply with Title VI and proposed a complex work plan. In December 2002, DCF and OCR signed a Voluntary Compliance Agreement to clarify the steps that DCF and OCR agreed to take to address the problems identified by OCR. The stated goal of the agreement is "to provide that actions are taken which will ensure that Hispanic and other immigrant minorities may apply for DCF-administered public benefits without facing discrimination and intimidation."

As part of the Agreement, DCF and OCR agreed to the following general principles:

1. 1. DCF agreed:
      1. not to deny benefits to otherwise eligible applicants because they do not provide SSNs or proof of immigration status of any non-applicant household member.
      2. not to deny benefits to persons who meet alien eligibility and other eligibility requirements mandated under Federal law.
      3. to allow family members to designate themselves as non-applicants on the initial application form, and as to those persons, to not inquire about SSN or immigration status for purposes of determining another's eligibility.
   2. OCR agreed to provide ongoing technical assistance as requested by DCF to implement the Agreement.

DCF agreed to take the following specific actions to ensure that its application and re-verification process does not deter or deny eligible applicants on the basis of race, color, or national origin:

1. 1. Revise the KidCare (SCHIP) application to clarify that only applicants are required to provide their SSNs, and to add language clarifying that SSNs will not be shared with the INS.
   2. Revise the joint application for public benefits to allow ineligible household members to be designated as non-applicants and to put information about emergency Medicaid on the form to ensure that eligible persons are not deterred from applying for the benefit.
   3. Revise several other forms used in the application and re-verification process.
   4. Strive to devote a portion of the outreach budget to increase participation by eligible persons in immigrant households, in recognition that immigrant participation in public benefit programs has been hampered by confusion and fear unique to the immigrant community.
   5. Review and revise existing policy as necessary to ensure that DCF staff do not inappropriately request or require SSNs or proof of immigration status.
   6. Develop employee training on procedures for requesting and verifying immigration status and SSNs, and deliver this training to all districts.

During its revision of forms and notices, DCF agreed to try to incorporate, wherever relevant and practicable, the following:

1. 1. Clear, understandable and necessary language.
   2. Consistent racial designations provided by the Office of Management and Budget.
   3. Enrollee participation or representation on workgroups to voice enrollee concerns and perspectives.
   4. On application forms:
      1. an immediate offer of assistance for persons with limited English proficiency and/or disabilities.
      2. a non-discrimination statement and description of the discrimination complaint process.
      3. clarification of possible misconceptions immigrants may have about INS public charge determinations and the effect, or lack thereof, that applying for Medicaid, SCHIP, TANF and other public benefits will have on such determinations.