An emergency room nurse tends to a patient at Houston Methodist The Woodlands Hospital in Texas. States, counties and nonprofits are striving to continue their work to close racial health disparity gaps but are struggling amid a loss of federal dollars. (Photo by Brandon Bell/Getty Images)

Racial health disparities may widen as states, universities and nonprofits grapple with federal funding cuts to programs that were aimed at filling gaps in care, public health experts say.

As part of its federal restructuring and crackdown on diversity, equity and inclusion (DEI) programs, the Trump administration has been shuttering federal offices and rescinding grants dedicated to addressing worse health care access and outcomes for racial minorities.

The shake-up has caused some state agencies and nonprofits to pause programs and some groups and universities to apply for foundation grants instead.

Hundreds of grants have been terminated for state, local and territorial health departments as well as nonprofits and universities, many of which addressed health equity across rural, low-income and communities of color.

The nation’s racial health disparities were laid bare during the COVID-19 pandemic, when the virus killed Black, Hispanic and Indigenous people at higher rates than white people. The police murder of George Floyd in May 2020 also fueled a racial reckoning across the nation, prompting efforts by states, universities, health systems and the federal government to address racial health disparities.

Those approaches ranged from targeted vaccine campaigns and efforts to enroll more people of color in clinical trials to corrections of diagnostic tests that relied on inaccurate information about race and biology.

Communities of color have long had less access to health care, increased exposure to environmental pollutants and higher rates of certain chronic illnesses and cancer deaths. They also have more diabetes-related amputations because of a lack of access to care. And specific genetic diseases, such as sickle cell disease, disproportionately affect Black people.

“COVID revealed the impact of health disparities to individual health — as well as how not addressing these disparities undermines the health system for everyone,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

Now, many of the programs trying to address health disparities are being rolled back.

As a result, health policy experts, clinicians and researchers fear those disparities will widen as states, universities and nonprofits grapple with lost federal dollars while the administration continues to limit federal funding for DEI programs. In July, the U.S. Department of Justice released guidance saying such initiatives should not receive federal funding, alleging they are “discriminatory.”

Entities that receive federal funds “must ensure that their programs and activities comply with federal law and do not discriminate on the basis of race, color, national origin, sex, religion, or other protected characteristics—no matter the program’s labels, objectives, or intentions,” the news release said.

Several state and local health officials were reluctant to speak with Stateline on the record about how the federal administration’s DEI crackdown has left them in a bind, fearing retaliation or targeting by the federal government. The White House did not respond to Stateline’s request for comment.

“My concern about what the administration is doing is that they are, in effect, making these disparities worse,” Benjamin said. “Everybody’s health is not the same. … It’s important to know that the disparities are really profound.”

Benjamin added that the cumulative effect of disparities means more late-stage disease — costing both patients and health systems more.

“There’s a trope or misunderstanding out there that DEI is a ‘woke’-related agenda. DEI is not a ‘woke’ agenda. DEI is an American agenda, because it’s really one that is the same thing as ‘rising tides lift all boats,’” said Brandon Wilson, senior director of Health Innovation and Public Health at Community Catalyst, a health equity advocacy organization. “When you cut [resources] off, you’re actually disproportionately impacting those who are already impacted.”

‘Increasing need’

The administration canceled billions of dollars in grants from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Environmental Protection Agency and the Department of Health and Human Services.

Many of the grants helped recipients create solutions tailored to their communities’ needs and strengths.

At least three dozen state, local and territorial health departments have had pandemic-era grants that addressed health equity terminated. While originally focused on COVID-19, agencies have since used that grant money for other public health efforts: testing and contact tracing for a wide range of diseases, better data reporting, and community partnerships that address social and environmental effects on health.

The money was part of a $2.2 billion national health equity initiative that aimed to address vulnerabilities and protect those communities ahead of the next outbreak.

The Department of Health and Human Services told media such cancellations were due to the pandemic emergency ending in 2023.

At NIH, the administration terminated more than 5,400 NIH research grants, although about 2,800 were reinstated. Canceled grants included research toward illnesses like HIV and AIDS, which disproportionately affect Black and Hispanic people as well as gay and transgender people.

The Trump administration has also gutted federal offices dedicated to fighting disparities, including the Offices of Minority Health under the Centers for Medicare & Medicaid Services and the Department of Health and Human Services.

At the state level, the Arkansas Department of Health recently shut down its own minority health-focused office. Ashley Whitlow, a spokesperson for the department, said in a statement that it “relies on federal grant funding to support a variety of public health programs.”

“The recent reduction in program staff reflects the Arkansas Department of Health’s ongoing efforts to operate more efficiently with the resources available. Despite these changes, ADH remains fully committed to serving communities across the state,” the statement said.

Meanwhile, Maryland’s Department of Health said its minority health office is funded through state general funds and not directly impacted by the federal cuts.

The nation has seen a spike in congenital syphilis cases, which disproportionately occur among Black and Indigenous families.

“Regardless of whether you’re at the highest risk, any outbreak that’s not controlled can spread widely and broadly, and you can see that that’s what’s happening with measles,” said Dr. Julie Morita, former executive vice president of the Robert Wood Johnson Foundation and former health commissioner Chicago Department of Public Health.

But states likely can’t replace all the lost federal dollars.

“You’ve got declining capacity, and increasing need — which is a formula for problems,” said Richard Frank, director of the Brookings Institution Center on Health Policy.

“It’s impossible to make all that up with state and local dollars,” he continued. “You’re going to see programs that serve real people getting pulled back.”

Frank and Wilson also expressed concern about the Medicaid changes included in the broad tax and spending law President Donald Trump signed in July. The law is projected to cut federal Medicaid spending by an estimated $911 billion over the next decade, largely because new work requirements will push people off the rolls. Data shows the majority of Medicaid enrollees already work, and experts say many will be kicked off the rolls due to difficulties in states’ reporting processes. Black and Hispanic people are disproportionately represented on the Medicaid rolls.

OB-GYN Dr. Versha Pleasant, a clinical assistant professor at the University of Michigan, directs the Cancer Genetics and Breast Health Clinic at Von Voigtlander Women’s Hospital. She treats patients at high risk for breast and ovarian cancers. Black women have an almost 40% higher risk of death from breast cancer than white women.

“That, to me, is unacceptable,” she said, adding that such disparities speak to the need for ongoing programs to “provide everyone with a fair chance at leading a long and healthy life.”

“If we don’t make a special effort to save the most vulnerable lives … where does that leave us?” she continued. “The changes that we’re seeing are only going to magnify preexisting challenges.”

Data and dollars

Dr. Sarah Rudman, acting public health officer at the Santa Clara County Public Health Department in California, and others have told Stateline that federal officials are informing health agencies that race and ethnicity data are no longer required to be reported.

“We are being asked to change the way we collect our own data here and report it,” Rudman said, adding that her county is going to continue collecting data to “understand who is here, who’s experiencing what health outcome and what they need.”

Many families, in the shadow of the county’s Silicon Valley, still struggle with poverty — more than 27,000 children suffer food insecurity, United Way Bay Area says.

“It is sometimes surprising and striking to people to understand how much poverty and other types of vulnerability are hidden among the more visible wealth of Silicon Valley, and that’s where we’ve dedicated our resources,” Rudman said.

“It’s hard to even imagine what my colleagues in smaller areas of California or in other parts of the country are experiencing,” she added about lower-income counties. “We are feeling extremely strained and already in our second round of layoffs, knowing that many more are likely. So I think that the hits are going to be that much more significant in areas who have less resources than we do.”

Federal officials also canceled the county’s $5.7 million grant to address COVID-19-related disparities, used to shore up vulnerable communities ahead of the next disease outbreak, natural disaster or heat wave, Rudman said. The money helped the county conduct basic laboratory testing and vaccine outreach for a wide range of diseases, not just COVID-19.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

File photo of the University of Nevada, Las Vegas, which is among the nation's largest Hispanic-serving institutions. Hispanic-serving institutions and other colleges and universities serving students of color will lose funding under a recent U.S. Education Department decision. (Photo by Hugh Jackson/Nevada Current)

WASHINGTON — The U.S. Department of Education announced it will withhold $350 million of congressionally approved funds to minority-serving colleges and universities and divert the funds elsewhere, saying that the institutions’ admissions quotas are discriminatory.  

The move eliminated fiscal 2025 discretionary funding for institutions that serve students who are Asian, Black, Indigenous and Hispanic, as well as a program for students of color pursuing careers in science and engineering. It’s consistent with President Donald Trump’s longstanding objective to eliminate programs that center on diversity, equity and inclusion.

“To further our commitment to ending discrimination in all forms across federally supported programs, the Department will no longer award Minority-Serving Institution grants that discriminate by restricting eligibility to institutions that meet government-mandated racial quotas,” Education Secretary Linda McMahon said in a statement.

McMahon cited a July opinion from the U.S. Justice Department that it was unconstitutional for federal funds to go to Hispanic-serving institutions based on the student body makeup.

That opinion reversed a decades-long record of the federal government setting aside funding for higher education institutions that have a significant portion of students from racial or ethnic minority backgrounds. 

The schools affected by Wednesday’s announcement are Alaska Native and Native Hawaiian-serving institutions; Black institutions; Asian American and Native American Pacific Islander-serving institutions; Native American-serving nontribal institutions; and institutions receiving Minority Science and Engineering Improvement grants. 

The announcement was vague about where the money would go instead, saying only it would be diverted “into programs that do not include discriminatory racial and ethnic quotas and that advance Administration priorities.”

Up to 800 schools affected

Democrats swiftly condemned the move, which is likely to face legal challenges.

Rep. Bobby Scott of Virginia, the ranking member on the U.S. House Education and Workforce Committee, said in a statement that the move undercut efforts to help students of color reach financial stability.

“These institutions are effective engines of economic mobility because they meet students where they are and are dedicated to educating the whole person,” Scott said in a statement.

Roughly 5 million students are enrolled in the more than 800 minority-serving institutions across the country. The schools aim to help students of color and students from low-income backgrounds pursue higher education. 

Most of the minority-serving schools receive funding based on racial quotas, except for Black institutions and tribal colleges, whose designations are based on their historical missions to educate Black or Native American students.

The Department of Education will also reprogram funds from a program to develop Hispanic-serving institutions and from a program promoting postbaccalaureate opportunities for Hispanic Americans.

McMahon argued that because most minority-serving institutions require that a percentage of the student body reflect the racial background the institutions serve, it violates the constitutional guarantee of equal protections. 

Administration cites equal protections

McMahon pointed to the Justice Department’s July memo saying it would not defend a suit brought by the state of Tennessee against Hispanic-serving institutions. 

The Supreme Court has explained that ‘[o]utright racial balancing’ is ‘patently unconstitutional,’” U.S. Solicitor General D. John Sauer wrote to House Speaker Mike Johnson. 

“And its precedents make clear that the government lacks any legitimate interest in differentiating among universities based on whether ‘a specified number of seats in each class’ are occupied by ‘individuals from the preferred ethnic groups,’” Sauer wrote.

The U.S. Supreme Court case that Sauer cited in his letter to Johnson is the 2023 decision to strike down affirmative action in college admissions that found two prominent universities’ consideration of race in acceptances violated the U.S. Constitution.

Most minority-serving institutions, about 70%, are Hispanic-serving institutions, according to Rutgers University’s Center for Minority Serving Institutions.

David Mendez, the head of the Hispanic Association of Colleges and Universities, an advocacy group, said in a statement that the loss in funding is “an attack on equity in higher education.”

“Cutting this funding strips away critical investments in under-resourced and first-generation students and will destabilize colleges in 29 states,” Mendez said. “The funds granted to HSIs have never supported only Latino students. These funds strengthen entire campuses, creating opportunities and resources that benefit all students, especially those pursuing (science, technology, engineering and math) fields, as well as enhancing the communities where these colleges and universities are located.”