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States are Paying $21B to Healthcare Providers to Prioritize Patients Based on Race

These incentives are called Health Equity Incentives (HEI). HEI focuses on racial disparities — meaning that providers score better by redirecting services to ‘underperforming’ races from other races.

HEI programs swept the country during the Covid and BLM panics. There are HEI programs in 35 states including Alabama, Arkansas, Louisiana, Mississippi, North Dakota, Ohio, Oklahoma, South Carolina, and West Virginia.

Massive healthcare providers spent tens of millions on HEI-related lobbying.

Despite Black Lives Matter losing popularity with the public, HEI continues to expand. Several of the largest wealth transfers programs have only been fully implemented during 2025–2026.

The history of HEI tells a fascinating story of power. NGOs and the Obama administration engineered HEI transfers decades ahead of BLM, when they seized the opportunity to pass sweeping race-based payments.

@HHS under Obama and Biden funded policy papers supporting HEI policies. States like Massachussetts laid the groundwork by collecting granular racial statistics.

Everything changed in 2020. This groundwork exploded into a massive ecosystem of HEI advocates, committees, and transfers. From October 2020 through May 2021, MassHealth held five listening sessions and 20 procured workgroup meetings with 100 organizations. 

By 2022, the State of Massachussetts announced the finalized $2.2B program. CMS approved it later that year. 

In California, the HEI ecosystem is larger and harder to track. Unlike Massachusetts, California frequently mixes racial wealth transfers into other incentive programs. California State officials frequently stated that they consider race to be the most important factor.

California Department of Health Care Services’ reporting code lists “Q-IHE1 Improving Health Equity — Priority,” alongside multiple additional “Q-IHE2 Improving Health Equity — Elective” classifications.

Despite political opinion turning on Black Lives Matter1, the HEI industry has not receded. HEI has higher budgets than ever before. Based on most recent reporting, they are active in 35 States and Washington, DC.

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