Things have changed.....

The evolving landscape of healthcare funding programs frequently intertwines with directives issued under executive orders.  Trump’s executive orders have changed the concepts followed by many health centers and may run counter to the board-approved programs and services, policies, procedures, and even job titles health centers have used for years.

That means that applications using disfavored language or frameworks may be disqualified, delayed, or flagged for additional review.  We must take care not to violate new federal guidance emphasizing race-neutral, merit-based criteria. 

Language around systemic racism, gender identity, or affirmative action may be seen as ideologically charged and noncompliance leading to rejection based on content regardless of program quality and efficiency.  If funds are seen as supporting prohibited activities under the new rules, there may even be the risk of current program year audits or funding freezes.

These orders can shape expectations for compliance, reporting, and operational standards, driving health centers to adapt rapidly to new criteria. For example, recent executive directives emphasize transparency in financial practices, comprehensive patient service reporting, and robust data security measures. These requirements necessitate a meticulous approach to grant applications, ensuring alignment with federally mandated guidelines.

1. Executive Order 14151 – “Ending Radical and Wasteful Government DEI Programs and Preferencing”[1]   This order terminated all diversity, equity, and inclusion (DEI) offices, positions, and programs within the federal government. It also ended equity-related grants and contracts, including those in healthcare agencies.  This eliminated DEI-related funding and programs that supported health equity initiatives in community health centers.

2. Executive Order 14173 – “Ending Illegal Discrimination and Restoring Merit-Based Opportunity”[2] This order revoked Executive Order 11246, which had mandated equal employment opportunity requirements for federal contractors. This move aimed at eliminating affirmative action policies in federal contracting.  This affects hiring and contracting practices for health centers receiving federal funds, potentially reducing workforce diversity.

These terms, concepts, activities, and programs may trigger additional review, rejection, or funding ineligibility under Trump-era executive orders:

1. Diversity, Equity, and Inclusion (DEI) Language

Keywords to use with caution or revise:

"Diversity training"
"Anti-racism"
"Implicit bias"
"Systemic racism"
"Equity-focused programs"
"Culturally responsive care"

Why it’s problematic: Executive Orders like EO 14151 ban DEI-related training and funding across federal programs, including healthcare.

2. Affirmative Action or Preferential Hiring Practices

Problematic concepts:

Hiring or contracting preferences for marginalized groups
"Affirmative action goals"

Why: These may conflict with EO 14173, which promotes “merit-based” decisions and rolls back prior affirmative action guidelines.

3. Race- or Gender-Specific Programming

Problematic phrasing:

Programs "targeted at Black, Indigenous, and people of color (BIPOC)"
Services “designed exclusively for women or transgender populations”

Why: These could be perceived as exclusionary or non-neutral under revised anti-discrimination interpretations.

4. Critical Race Theory and Related Frameworks

Red flags:

References to “privilege,” “whiteness,” or “oppression frameworks”
Curricula or programs using CRT-based pedagogy

Why: Trump's earlier EO (from 2020, EO 13950, reintroduced in spirit in newer orders) explicitly called out these ideas as “divisive.”

5. Health Equity Framing

Potentially problematic:

“Structural determinants of health”
“Equity-centered healthcare delivery”

Why: Language that attributes disparities to systemic injustice may face pushback under revised guidelines that de-emphasize structural explanations.

6. Intersectionality and Identity Politics

Avoid using:

“Intersectional lens”
“Marginalized identities”
“Queer communities”

Why: The administration may consider these terms ideological or politically motivated rather than scientific or policy-neutral.

This is an example of a pre-Trump era, well-written passage in a HRSA Grant Application:

“Our program is designed to address systemic racism in healthcare by expanding access to culturally responsive, anti-racist care for BIPOC and LGBTQ+ communities. We will use an intersectional framework to train providers in implicit bias, ensuring care delivery is inclusive, equitable, and justice-driven. The initiative prioritizes historically marginalized populations and partners with local DEI organizations.” 

This is an example of how FQHC INC would re-write the passage to use language more aligned to the current administration’s ethics and goals:

“Our program is designed to improve access to high-quality, community-based healthcare for underserved and medically vulnerable populations. We aim to support evidence-based practices that enhance patient engagement, increase service utilization, and improve health outcomes in historically under-resourced areas. Provider training will focus on patient-centered communication and population-specific health trends, supported by partnerships with local community health organizations.”
 
These are the key adjustments made and why:

 

 
Click here for a white paper on how to survive today's environment in writing your grant narratives.  Don't forget to review all terminology in the budget, job descriptions and other attachments, and the personnel tables!  

[1] Executive Order 14151 – “Ending Radical and Wasteful Government DEI Programs and Preferencing” January 20, 2025.   https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-and-wasteful-government-dei-programs-and-preferencing/?utm_source=chatgpt.com

[2] Executive Order 14173 – “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” January 20, 2025.  https://www.whitehouse.gov/presidential-actions/2025/01/ending-illegal-discrimination-and-restoring-merit-based-opportunity/?utm_source=chatgpt.comType your paragraph here.