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Instances of racial discrimination in health care continue despite the enactment of civil rights laws, such as Title VI of the Civil Rights Act of 1964 *329 (Title VI). Title VI prohibited racial discrimination by health care entities receiving government funding such as Medicaid payments. The federal government focused its initial efforts on hospitals. Because hospitals relied on federal funding, the federal government was able to force hospitals to integrate without much resistance from the hospital industry. However, since this accomplishment the government has relied too heavily on assurances of compliance from other health care entities, such as nursing homes, with minimal follow up. Thus, it comes as no surprise that research studies suggest that racial discrimination persists in the provision of health care, particularly nursing home care.

Research studies discussed in Part I suggest that elderly African Americans disproportionately reside in poor quality nursing homes compared to Caucasians as a result of racially discriminatory practices. For example, research shows that, even when other factors such as residential segregation and socioeconomic status are controlled, significant racial inequities in access to quality nursing home care still exist. Moreover, empirical data from several states, including New York, North Carolina, and Illinois, show that race remains the greatest predictor of the provision of poor quality nursing home care. These studies suggest that racial *330 discrimination, in the form of both disparate treatment and disparate impact, is the cause.