Conscience Protections

On January 9, 2024, the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) announced a Final Rule entitled Safeguarding the Rights of Conscience as Protected by Federal Statutes.

The Final Rule clarifies the process for enforcing federal conscience laws and strengthens protections against conscience and religious discrimination. This important Final Rule is a part of HHS’ actions in furtherance of Executive Order 13985, entitled Advancing Racial Equity and Support for Underserved Communities Through the Federal Government.

• Read the Final Rule (89 FR 2078).
• Read the press release on the Final Rule (January 9, 2024).
• Read the fact sheet: Safeguarding the Rights of Conscience as Protected by Federal Statutes .
• Watch the webinar: OCR Informational Webinar – Conscience Rule (January 10, 2024).

Your Conscience Rights

Conscience protections apply to certain health care providers, patients, and other participants in specific federal programs who refuse on religious or moral grounds to participate in certain health care services.

Federal statutes protect health care conscience rights, including by prohibiting recipients of certain federal funds from requiring certain individual providers to participate in actions they find religiously or morally objectionable. Some providers for example, object for religious or moral reasons to providing or referring for abortions or assisted suicide, among other procedures. These statutes also provide protections against discrimination based on individuals’ religious or moral beliefs about certain health care services.

Several provisions also protect the conscience rights of certain federally funded health care entities to not participate in actions they find religiously or morally objectionable.

Regarding patients, other provisions clarify that certain programs related to mental health treatment, hearing screening programs, occupational illness testing, and compulsory health care services generally are not to be construed to require patients to receive certain health care services to which they object based on religious or moral beliefs.

More information about the various Federal Health Care Conscience Protection Statutes can be found below and in the Statutory Background section of the Final Rule.

How to File a Conscience Complaint

You may file a complaint with OCR if you believe you have been discriminated against in violation of the Federal Health Care Conscience Protection Statutes. You can file a complaint online or via mail, fax, or e-mail. Learn more about how to file a complaint with OCR.

For information about receiving an Assurance of Exemption under Applicable Federal Religious Freedom and Conscience Protections under OCR’s Regulation implementing Section 1557 of the ACA, visit www.hhs.gov/1557

Federal Health Care Conscience Protection Statutes

The Final Rule clarifies existing authorities and processes for handling complaints related to federal health care conscience protection statutes. OCR receives complaints under the federal conscience statutes, and a short summary of those statutes is below.

For a more detailed summary of conscience statutes, read the Statutory Background section of the Final Rule.

The Church Amendments

The conscience provisions contained in 42 U.S.C. 300a-7, et seq., collectively known as the Church Amendments, were enacted in the 1970s to protect the rights of individuals and entities to object to performing or assisting in the performance of certain procedures because of their religious beliefs or moral convictions. These provisions:

• Prohibit public officials and authorities from requiring recipients of certain federal financial assistance to provide or make their facilities available for abortion or sterilization when the recipient has a religious or moral objection to sterilization or abortion.
• Prohibit entities that receive certain federal financial assistance from discriminating against physicians and health care personnel:
  • because they performed a lawful sterilization, abortion, or other lawful health service or research activity,
  • because they refused to perform a lawful sterilization, abortion, or other lawful health service or research activity, or
  • because of their religious beliefs or moral convictions about sterilization, abortion, or any other lawful health services or research activities.

  Public Health Service Act § 245 (The Coats-Snowe Amendment)

  Enacted in 1996, section 245 of the Public Health Service Act, contained in 42 U.S.C. 238n, also known as the Coats-Snowe Amendment, prohibits the federal government and any state or local government receiving federal financial assistance from discriminating against any health care entity on the basis that the entity:

  • Refuses to undergo training in the performance of abortions;
  • Refuses to require or provide abortion training;
  • Refuses to perform abortions, or to provide referrals for abortion training or for abortions;
  • Refuses to make arrangements for any of the above activities related to abortion; or
  • Attends (or attended) a post-graduate physician training program, or any other program of training in the health professions, that does not (or did not) perform induced abortions or require, provide, or refer for training in the performance of induced abortions, or make arrangements for the provision of such training.

  The Weldon Amendment

  The Weldon Amendment was originally passed as part of the HHS appropriations act for 2005, and has been readopted (or incorporated by reference) in each subsequent HHS appropriations act since then. It provides that none of the funds made available in those HHS appropriations acts may be made available to a Federal agency or program, or to a state or local government, if the agency, program, or government discriminates against any institutional or individual health care entity on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions. It defines “health care entity” to include “an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.”

  The Affordable Care Act

  Passed in 2010, the Patient Protection and Affordable Care Act (ACA), Public Law 111–148, as amended by Pub. L. No. 111-152, (codified at 42 U.S.C. 18001, et seq.), includes certain conscience provisions in sections 1553, 1303(b)(1)(A), (b)(4), and (c)(2)(A), and 1411(b)(5)(A).

  Section 1553 of the Affordable Care Act (42 U.S.C. 18113) (ACA) includes conscience protections regarding assisted suicide. The provision prohibits the Federal Government, and any State or local government or health care provider that receives Federal financial assistance under the ACA, or any health plan created under the ACA from discriminating against an individual or health care entity on the basis that the individual or entity does not provide any health care item or service for assisted suicide, euthanasia, or mercy killing.

  Section 1303(b)(1)(A) (42 U.S.C. 18023(b)(1)(A)(ii)) allows a qualified health plan to determine whether or not to provide coverage of abortion services. Section 1303(b)(4) (42 U.S.C. 18023(b)(4)) prohibits a qualified health plan offered through an Exchange from discriminating against “any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.” Section 1303(c)(2)(A) (42 U.S.C. 18023(c)(2)(A)) notes that nothing in the Affordable Care Act affects Federal laws regarding conscience protection and discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion, or to provide or participate in training to provide abortion.

  Section 1411(b)(5)(A) (42 U.S.C. 18081(b)(5)(A)) addresses exemptions to the ACA’s “individual responsibility requirement.” Under this section, the Department may grant exemptions based on hardship (which the Department has stated includes an individual's inability to secure affordable coverage that does not provide for abortions (84 FR 23172), membership in a particular religious organization, or membership in a “health care sharing ministry”).

  Other HHS Authorities

  OCR also accepts complaints alleging violations of a number of conscience protections in the Medicare and Medicaid programs, as well as various other programs across the Department.

  Under Medicare and Medicaid programs, these include provisions related to:

  • providing, reimbursing, or covering, certain counseling or referral services i
  • conscience provisions related to the performance of advanced directives ii
  • provisions related to Religious Nonmedical Health Care Institutions and their patients iii
  • compulsory health care services under Medicaid iv

  Under other Department programs, these include provisions related to:

  • certain programs administered by the HHS Office on Child Abuse and Neglectv
  • the HHS Strengthening Early Hearing Detection and Intervention (EHDI) Programvi
  • National Institute for Occupational Safety and Health (NIOSH) requirements for occupational illness testing vii
  • the HHS Vaccines for Children Programviii
  • the HHS Center for Mental Health Services Garrett Lee Smith (GLS) Suicide Prevention Program ix
  • provisions prohibiting coercion for abortion or sterilization x and protecting conscience and prohibiting discrimination xi tied to HHS programs under the President's Emergency Plan for AIDS Relief (PEPFAR).

  Past Actions

  • February 17, 2023, Closure Letter Regarding Illinois Weldon Investigation
  • January 5, 2023, Notice of Proposed Rulemaking, Safeguarding the Rights of Conscience as Protected by Federal Statutes (88 FR 820)
  • September 17, 2021, Guidance on Nondiscrimination Protections under the Church Amendments for Health Care Personnel
  • August 13, 2021, Letter Withdrawing January 24, 2020, Notice of Violation Issued to the State of California
  • July 30, 2021, University of Vermont Medical Center Letter
  • December 16, 2020, HHS to Disallow $200M in California Medicaid Funds Due to Unlawful Abortion Insurance Mandate; Refers Vermont Medical Center to DOJ for Lawsuit Over Conscience Violations
  • January 24, 2020, HHS Issues Notice of Violation to California for its Abortion Coverage Mandate
  • May 21, 2019, Final Conscience Rule, Protecting Statutory Conscience Rights in Health Care; Delegations of Authority (84 FR 23170)
  • March 22, 2019, Notice of Resolution to the State of Hawaii After Hawaii Takes Action in Safeguarding Conscience Protections for Pregnancy Care Centers
  • January 18, 2019, State of California FACT Act Notice of Violation
  • June 21, 2016, Closure Letter Regarding California Weldon Investigation
  • February 23, 2011, Final Conscience Rule, Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws (76 FR 9968)
  • December 19, 2008, Final Conscience Rule, Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law (73 FR 78072)