Section 1557 of the Affordable Care Act (ACA) imposes a nondiscrimination requirement that prohibits individuals from being excluded from participation in, being denied the benefits of, or being subject to discrimination under a health program or activity that receives federal financial assistance on specified grounds (42 U.S.C. § 18116; see Practice Note, Affordable Care Act (ACA) Overview). Specifically, ACA Section 1557 prohibits discrimination on the basis of race, color, national origin, age, disability, or sex in covered health programs and activities.

Section 1557 has been the topic of significant implementing regulations issued by three successive presidential administrations (including the current one). These implementing regulations include:

Although the Biden administration's August 2022 re-proposed regulations would not expressly apply to group health plans, the regulations would impose extensive requirements on health insurers, third-party administrators (TPAs), and other entities (including health providers) that receive federal financial assistance. For example, the re-proposed regulations would prohibit Section 1557 covered entities from categorically excluding coverage or imposing limitations or additional cost-sharing for all gender-affirming care if the exclusion or other limits result in discrimination on the basis of sex. The Biden administration did not finalize its August 2022 re-proposed regulations during 2023.

Section 1557 also has been the topic of significant and ongoing litigation. For recent examples of this litigation, see:

Against this rapidly changing regulatory and litigation backdrop, this Toolkit provides a collection of compliance resources for use by health plan sponsors, health insurers, TPAs, other service providers, and their advisors in offering health plan benefits in compliance with ACA Section 1557.