Since June 2023, most health care providers in New York working on projects that require a Certificate of Need (CON) have had to include a Health Equity Impact Assessment (HEIA) with their CON application. These HEIAs use a combination of data analysis and public engagement to inform the applicant and the State of the effects on community health and health disparities that could result from the project.
Although the Trump Administration is seeking to dismantle diversity, equity, and inclusion initiatives in the federal government, the HEIA process is required under state law, and New York State remains committed to advancing health equity and reducing health disparities.
Sachs Policy Group (SPG) has been deeply involved in the HEIA initiative, having completed over 20 assessments since the law went into effect. With 2025 kicking off and providers moving forward with their capital plans for the year, we thought we’d share some of our learnings from the past 18 months.
If we can help you with an HEIA, or if you simply have any questions about the process, feel free to reach out to Jaclyn Pierce at jpierce@sachspolicy.com.
Our takeaways on the HEIA process so far:
- Assessments are all thoroughly reviewed and need to be comprehensive. Our experience is that DOH’s HEIA unit critically analyzes every HEIA that crosses its desk. That means no project qualifies for a “partial” or “slimmed down” HEIA. Some projects may be smaller in scope (and cost), but all projects need to fully and robustly complete the DOH HEIA template to be approved.
- DOH has flexible “meaningful engagement” expectations, but only to a degree. DOH recognizes that each project’s stakeholder engagement process will be customized and, in practice, its expectations for a hospital seeking to close an existing unit are much higher than for an outpatient clinic adding a new service line. Yet this flexibility has its limits, and DOH expects community feedback even for projects that don’t have any obvious potential for negative health equity impacts. We’ve developed meaningful engagement strategies for projects as small as adding on-site dialysis to better support nursing home residents, ensuring we balance the need for adequate feedback while also respecting the valuable time provided to us by clinical providers, patients, and community members.
- Keep good records, and be prepared to provide them. DOH has developed a template spreadsheet for collecting meaningful engagement data, which it cross-references when reviewing the write-up included in the HEIA itself. Yet we’ve found that DOH routinely asks for backup information, including interview scripts, notes, survey responses, and even transcripts to support its analysis. Although DOH is aware that not all of this information is always available, SPG has found that carefully documenting as much as possible smooths the HEIA process and helps keep projects on-time.