New Health Equity Impact Assessment Law in New York Beginning to Show Results 

A year after New York’s new health equity impact assessment law went into effect on June 22, 2023, the initial outcomes of this first-in-the-nation reform of state hospital oversight are beginning to emerge. The Burdett Birth Center located in Samaritan Hospital in upstate Troy was saved from closure after two health equity assessments (one commissioned by the hospital, as required under the new law, and another done by a community coalition) predicted negative consequences for area residents who rely on the center. Other equity assessments have helped pinpoint the need for health facilities to improve language access, community outreach and access for people with disabilities. 

Assessments Identify Negative Impact of Burdett Birth Center Closure 

Both assessments of the proposed Burdett Birth Center closing found that pregnant women from the 22% of Troy households without cars and those living in distant rural areas of Rensselaer County would have difficulty traveling to other regional hospitals. The community assessment reported that Black pregnant women, who experience high rates of maternal mortality and morbidity, were concerned that they would be deprived of a midwife-led birth center with a low C-section rate where they felt respected and safe. The community assessment also questioned whether other hospitals in the region could absorb the patients who would be displaced from Burdett. 

“The Health Equity Impact Assessment (HEIA) process as applied to Burdett Birth Center was extremely beneficial,” said state Assemblymember John T. McDonald III, RPh, who represents the district in which Burdett is located. “Taking a closer look at closure proposals and allowing meaningful engagement with impacted communities was the goal of the HEIA process and Burdett is evidence of how important this process is.” 

The hospital’s parent system, St. Peter’s Health Partners, delayed closure of the birth center while it tried to mitigate the identified negative impacts, as required by law, including attempting to devise a transportation plan to the system’s main “hub” hospital in Albany. The delay bought time for Assemblymember McDonald to win inclusion of a $5 million five-year grant in the state budget to fund a demonstration project at the Burdett Center that will focus on methods of reducing maternal mortality.  McDonald and members of the Save Burdett Birth Center Coalition believe the project will help document and make more visible the center’s successes, thereby attracting a wide patient base from outside Rensselaer County and stabilizing finances. 

“In minority communities,” McDonald explained, “there is a large distrust of the health care system but a strong bond between doulas and midwives which makes the Burdett Birth Center so well-respected. My hope is that through greater involvement and study through the grant we can expand the midwife centered/led service which resonates so well within the community.” 

The Assessment Process 

So far, more than a dozen health equity impact assessments have been received by the state Department of Health and evaluated by staff in its new Office of Health Equity and Human Rights. The assessments are carried out by independent entities commissioned by health facilities and are submitted along with the facility’s certificate of need (CON) application. The assessments are required for major construction projects or to add, expand, or reduce services. Mergers of health facilities are exempt, unless the merger would cause the elimination or reduction of services. Also exempt are clinics that already serve primarily Medicaid enrollees or uninsured people and, as described below, closings of entire health facilities.  

Each assessment must identify the number and type of medically underserved people who would be affected by the facility’s proposed project, include meaningful engagement of those medically underserved people, identify any negative health equity impacts of the project, and include a plan to mitigate any identified impacts. Medically underserved is defined to include racial and ethnic minorities, women, LGBTQ+ people, people with disabilities, immigrants, older adults, rural residents, and people who are uninsured or publicly-insured. Meaningful engagement may include hosting a community forum, circulating a survey, conducting phone interviews or other means, depending on the scope of the proposed project. 

Health equity assessments are posted on the NYSE-CON page of the New York State Department of Health website along with each CON application, so the public may review the assessment findings and submit comments. CON applications for major projects are reviewed in public meetings by the state Public Health and Health Planning Council (PHHPC), affording community members an additional opportunity to provide comments. One recent CON application to construct an addition to White Plains Hospital included in its assessment a mitigation plan to address health equity issues raised through community engagement, including improving language access for Spanish-speaking patients, increasing the number of bilingual staff, and improving accessibility for people with disabilities.  

Acting Deputy Commissioner for Health Equity and Human Rights Tina Kim explained at a March PHHPC meeting that “for the first time, the department is going to gain information about health equity systemically and comprehensively across projects.” Over time, she said, the department “can begin to analyze on a macro level the overall health equity impact of these projects.” 

Potential Improvements 

How might the assessment process be improved, based on the first year’s experience with the law? While the law and implementing rules require that independent assessors be unbiased and certify that they do not have an interest in approval of the specific proposed project being evaluated, so far the assessors have been private consulting firms that do regular business with health facilities. Health equity advocates worry that the firms’ ongoing relationships with hospitals could cause them to downplay impacts of projects or propose inadequate mitigation plans. However, the firms must follow a very detailed series of steps outlined by the department and use a department form to submit findings. Kim said department staff have been in frequent consultation with assessors and “the desire to learn and understand what the department expects is very clear.” She added that “many firms and entities are building their capacity to do this service, so it’s definitely been a learning curve.” 

Health advocates who pushed for the health equity assessments have been busy trying to address a worrisome gap in its applicability. Proposed closures of entire hospitals — as opposed to units, such as maternity or emergency care — are not required to undergo health equity impact assessments. That’s because such closures are carried out through a process of giving notice to the Department of Health and filing a closure plan, but do not involve submitting a CON application. Since the health equity law amended the CON process, it left out hospital closures. A bill to require CON applications and equity assessments for hospital closure (S8433A/A1633B) passed both house of the state Legislature in early June and will be headed to Gov. Kathy Hochul’s office for her consideration.  

“Closures of hospitals can be devastating to affected communities, especially medically underserved people such as people with disabilities, pregnant people, people of color and people who are uninsured or underinsured,” said Elisabeth Ryden Benjamin, Vice President for Health Initiatives of the Community Service Society of New York, when the bill passed the state Assembly. “It is vital that such proposed changes receive the highest level of state review and are subject to health equity impact assessments.”