Health care providers, Health Insurance Exchange, Medicare and Medicaid Advantage and supplement health plans, and other Department of Health and HumanServices funded or regulated entities should heed the May 18, 2026, U.S. Department of Health and Human Services (HHS) announcement of its reorganization of its Office for Civil Rights (OCR) as a strong signal of HHS’ continued heightened prioritization of enforcement of conscience and religious freedom rights under the Trump Administration’s policies.
Additionally, recent guidance and the new HHS enforcement priorities also increase risks that organizations could face religious discrimination, whistleblower or other private litigation.
As compliance with federal conscience and religious freedom rights a term of HHS program participation, HHS funding recipients must comply with these requirements to qualify for program participation, Medicare, Medicaid and other HHS program recipients must ensure their policies and practices meet these and other current HHS standards to withstand potential program disqualification, False Claims Act liability and other adverse consequences that noncompliance could create.
OCR Reorganization
The reorganization of the HHS agency charged with enforcing HHS-administered laws protecting civil rights, conscience and religious freedom, and health information privacy and security, the announced reorganization returns OCR to a program-based structure that elevates conscience and religious freedom protection enforcement by realigning OCR into three distinct subject-matter divisions:
- The Conscience and Religious Freedom Division,responsible for enfocing federal rights of conscience and religious freedom
- The Civil Rights Division, responsible for enforcing Section 1557 and other civil rights and disability laws implemented and enforced by HSS; and
- The Health Information Privacy, Data, and Cybersecurity Division, responsible for implementing and enforcing the privacy, data security, data breach and privacy rights of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Genetic Information Nondiscrimination Act (GINA) and other privacy and data security requirements implemented and enforced by HHS.
Historical Background Leading To Reorganization
HHS originally established the OCR Conscience and Religious Freedom Division (CRFD) to handle federal enforcement of the nation’s laws that protect the rights of conscience and religious freedom protected under the United States Constitution and other federal laws in January 2018 during President Trump’s first presidency. That division enforced and raised public awareness of conscience and religious freedom laws in health and human services, underscoring that violations are serious infractions that transgress basic human dignity and fundamental rights.
CRFD operated until March of 2023, when the Biden administration dissolved the division as part of its deemphasis on these protections and other Biden Administration actions taken to mitigate the Dobbs. Although OCR maintained jurisdiction over conscience and religious freedom authorities in health and human services after 2023, the Biden Administration combined the Conscience and Religious Freedom Division and the then-Civil Rights Division into the Policy Division.
Key Reorganization Goal Strengthening Conscience Rights and Religious Freedom Enforcement
According to OCR’s May 18 announcement, the reorganized structure will improve OCR’s effectiveness and efficiency to advance the protection of conscience rights, address race-based discrimination in a color-blind manner, eradicate antisemitism and anti-Christian bias, and restore biological truth. The intake and processing of complaints filed with OCR, and the review of reported breaches involving unsecured protected health information, will continue to be handled by an Enforcement Division that supports centralized intake and field-office execution. The reorganization is not expected to result in a reduction of OCR’s workforce.
The announcement highlights this goal by quoting HHS Office for Civil Rights Director Paula M. Stannard as saying, “This reorganization reinstitutes a structure that rightly prioritizes civil rights and conscience and religious freedom alongside health information privacy and security,” and that “All three areas are deserving of subject-matter expertise and distinct senior executive leadership for OCR to best serve the American people.”
The restructuring to support greater emphasis by OCR on enforcement of conscience and religious freedom rights follows a series of other actions already taken by HHS to protect healthcare providers, health insurers, employer and other health plans and their sponsors and others from being penalized for refusing to cover or pay for abortion by states or other entities covered by the rights of conscience rules of the Weldon Amendment enforced by OCR under Trump Administration priorities.
The Weldon Amendment, among other things, prohibits federal, state, or local government discrimination against health care entities that choose not to pay for, or provide coverage of, abortion.
Since President Trump began his second administration, OCR initiated a host of policy revisions and investigations in furtherance of President Trump’s priorities of protecting rights of conscience and human life. See Fact Sheet: HHS Takes Comprehensive Action to Enforce Conscience Rights and Protect Human Life, and OCR’s conscience and religious freedom webpage.
OCR’s announcement builds upon the Trump Administration policy and HHS’ resulting recent efforts to enforce federally protected right of conscience protections and protect human life.
Among other things, OCR has taken action to protect health care workers, support whistleblowers, and reinforce adherence to religious and conscience exemptions in the Vaccines for Children Program as part of these policies.
Earlier this year, OCR also issued a Notice of Violation that found an Illinois state law violated the Weldon and the Coats-Snowe Amendments, which are part of the two dozen federal health care conscience protection statutes that HHS enforces. The Illinois Notice of Violation charged the Illinois law unlawfully ties health care provider conscience protections to referral requirements in the case of abortion.
On March 19, 2026, for example, OCR announced its investigation of 13 states for allegedly violating the Weldon Amendment federal health care conscience law by coercing health care entities, health insurers, and employers and their health plans to provide coverage of, or pay for, abortion contrary to conscience.
After it repudiated a 2021 Biden Administration era letter that excluded employers and plan sponsors from the scope of health care entities protected by the Weldon Amendment, OCR notified states and other regulated entities no longer rely on the now-repudiated legal position.
OCR Director Paula M. Stannard is quoted as stating, “Under the Weldon Amendment, health care entities, such as health insurance issuers and health plans, are protected from state discrimination for not paying for, or providing coverage of, abortion contrary to conscience. Period.”
Along with the charges against Illinois, OCR also:
- Issued three public notices describing OCR deregulatory actions to align with President Trump’s E.O. 14182, Enforcing the Hyde Amendment; and
- Issued nationwide Dear Colleague Letter explaining OCR’s right of conscious policy under the Trump Administration.
That guidance rescinded and repudiated certain Biden Administration era policies that the Trump Administration viewed outdated or inconsistent with the law as construed and enforced by the Trump Administration.
To educate the public, OCR also released a nationwide Dear Colleague Letter summarizing federal health care conscience protection statutes, including those laws specific to abortion, sterilization, and assisted suicide.
Pending that additional guidance, health care providers, health insurers and plans, and other entities subject to HHS jurisdiction should exercise care to ensure their policies and procedures properly align with OCR right of conscience and religious freedom enforcement policies.
The OCR reorganization announcement reports OCR will publish more information about the reorganization in a Federal Register notice in June. Subscribe to this publication and stay tuned for more developments.
For Help or More Information
The author of this update, Cynthia Marcotte Stamer has decades of experience advising and assisting health industry clients to design, audit, and defend their organizations and practices including conducting audits and investigations, designing and updating compliance and risk management programs, responding to government investigations, conducting transaction, governance, and other due diligence, and assisting with other legal and operational compliance and risk management and legislative and regulatory affairs. She is available to assist your organization in assessing the impact of these developments and navigating the compliance and strategic steps that follow. For more information about these or other health care, managed care and other health benefits, or other health industry laws or concerns, contact Ms. Stamer via e-mail or via telephone at (214) 452 -8297.
About the Author
Peer recognized as “Top Rated Lawyer” and “LEGAL LEADER™ “Top Rated Lawyer” and “Best Lawyer” for her work in Health Care Law, Labor and Employment Law; ERISA & Employee Benefits,” and “Business and Commercial Law,” Cynthia Marcotte Stamer is an A Martindale-Hubble “AV-Preeminent” (Top 1%) attorneys board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for her more than 35 years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications including leading edge work on PBM, pharmacy and pharmaceutical and other health care, managed care, insurance, and insured and self-insured contracting, design, administration and regulation..
Author of numerous highly regarded works on health care fraud and other compliance, risk management and operations, Chair of the Tort Trial and Insurance Practice Section Medicine and Law Committee, past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, the ABA International Section Life Sciences Committee and the former Group Chair and Welfare Benefit Committee Co-Chair of the ABA RPTE Employee Benefits & Other Compensation Group, Ms. Stamer is widely recognized for her decades of pragmatic, leading edge work, scholarship and thought leadership on health industry legal, public policy and operational concerns.
Ms. Stamer’s work throughout her career has focused heavily on working with hospitals, health care systems, long term care, rehabilitation, home health, hospice, clinics, and other health care organizations; physician and other provider organizations and practitioners; accreditation, medical staff, peer review, and quality committees and organizations; billing, audit, practice management, utilization management, EMR, claims, payroll and other technology, billing and reimbursement and other services and product vendors and services organizations; pharmaceutical, pharmacy, and prescription benefit management and organizations; DME; health care and managed care, health and other employee benefit plan, insurance and financial services and other public and private organizations; consultants; products and solutions consultants and developers; investors; managed care organizations, self-insured health and other employee benefit plans, their sponsors, fiduciaries, administrators and service providers, insurers and other payers, health industry advocacy and other service providers and groups and other health and managed care industry clients as well as federal and state legislative, regulatory, investigatory and enforcement bodies and agencies on billing and reimbursement, government investigations and enforcement, and other legal and operational compliance and risk management, performance and workforce management, regulatory and public policy, and other legal and operational concerns.
Author of a multitude of highly regarded publications and presentations, Ms. Stamer is widely recognized for her thought leadership on these and other health care, managed care and other health plan,and other health industry matters. In addition, Ms. Stamer contributes her time and leadership to numerous policy, professional, civil and other organizations including service as the, the American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting and a former Council Representative, Past Chair of the ABA Managed Care & Insurance Interest Group, former Vice President and Executive Director of the North Texas Health Care Compliance Professionals Association, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, and a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her extensive publications and thought leadership as well as leadership involvement in a broad range of other professional and civic organizations. For more information about Ms. Stamer or her health industry and other experience and involvements, see www.cynthiastamer.com or contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
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