Earlier this month, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced that it opened a new investigation into a state health department’s behavioral-health licensing practices. The investigation will examine whether the state’s licensing standards, interpretations, or enforcement activities for behavioral-health facilities and licensed professionals comply with federal conscience and equal-treatment laws.
Notably, this investigation marks OCR’s fifth action since January 20, 2025, and it did not disclose the state under investigation. OCR emphasized that the review is particularly significant in light of national behavioral-health workforce shortages and the federal government’s interest in ensuring that qualified professionals are not deterred from practice based on conscience-related concerns.[i]
Scope of OCR’s Review Reflecting White House’s Agenda
OCR’s announcement indicates that the agency is evaluating potential noncompliance and it will assess whether the state’s licensing processes improperly:
Discriminate against faith-based organizations when administering or enforcing licensing requirements, including through standards that treat religious objections as grounds for adverse licensure action;
Discriminate against healthcare entities that decline to provide, cover, pay for, or refer for abortion based on religious or moral objections; and/or
Require individuals participating in HHS-funded programs to perform services that conflict with their religious beliefs or moral convictions, including counseling or other assistance related to abortion or gender-related care.[ii]
While OCR noted that the investigation proceeds under the Equal Treatment for Faith-Based Organizations rule[iii] (45 C.F.R. part 87), the Weldon Amendment[iv], the Coats-Snowe Amendment[v] (42 U.S.C. § 238n), and the Church Amendments[vi] (42 U.S.C. § 300a-7), some health policy experts are alarmed by these actions, noting they may restrict transgender healthcare nationwide and pressure providers into suppressing medical services, specifically access to gender-affirming medicine.
Treatment of Existing State Practices and Potential Enforcement Outcomes
While OCR has not yet identified specific violations, the investigation suggests that the agency is examining the state’s licensing policies, interpretations, and enforcement patterns.
If OCR determines that the state’s practices conflict with federal law, potential outcomes may include corrective-action plans, changes to enforcement processes, or, in severe cases, implications for federal funding tied to compliance with conscience protections. Notably, OCR’s announcement directly references the agency’s authority to enforce religious-nondiscrimination requirements across HHS grant and block-grant programs.
What to Expect Next from HHS and State Licensing Authorities
OCR’s press release suggests that further enforcement activity is likely. Providers, state licensing bodies, and faith-based organizations should anticipate:
Greater scrutiny of licensing and certification standards, particularly those that implicate contested services such as abortion and gender-related procedures;
Closer examination of adverse licensure actions, including whether objections based on conscience or religious beliefs have been considered; and
Expanded review of compliance across HHS-funded programs, not limited to behavioral health.
In the interim, state agencies may want to assess whether their existing licensing rules or interpretations could raise compliance questions and providers may wish to review internal policies addressing religious-objection processes, staff assignments, and licensure-related disclosures.
Looking Ahead
Given this Administration’s commitment to strengthening enforcement, stakeholders should expect continued focus on licensure-based barriers, equal treatment of faith-based organizations, and alleged discrimination arising from objections to abortion or gender-related care.
With that said, OCR’s enforcement capacity is currently limited as it is estimated that HHS cut around 20,000 positions in 2025. The fact that OCR has opened new conscience-related investigations this year, even as OCR sheds resources, suggests these types of investigations remain a significant area of focus. Healthcare providers should take note that while OCR may not have the bandwidth for comprehensive monitoring, compliance obligations remain and enforcement based on conscience protections are on the horizon.
Further contributions to this article by Oscar Leija
FOOTNOTES
[i] Press Release, U.S. Dep’t of Health & Human Servs., Office for Civil Rights, HHS Investigates State Health Department to Protect Conscience Rights and Ensure Equal Treatment of Faith-Based Organizations (Dec. 9, 2025). (https://www.hhs.gov/press-room/ocr-investigates-state-to-protect-conscience-and-faith-based-organizations.html)
[ii] Id.
[iii] Sets equal treatment standards for faith-based organizations in federally funded programs.
[iv] Prohibits discrimination against entities that do not provide, pay for, cover, or refer for abortion.
[v] Protects physicians and training programs from being required to perform or train in abortion.
[vi] Prohibits discrimination against individuals and entities for declining to perform or assist with procedures contrary to religious beliefs or moral convictions.