- Are there laws protecting transgender people’s right to health care?
- Is my doctor supposed to keep my transgender status private?
- What should I do if a health care provider discriminates against me?
- How can I find a transgender-friendly health care provider?
- Do I need a specialist just because I’m transgender?
- Where can doctors find answers to questions about treating transgender patients?
- Should I seek care usually associated with transgender men and women?
- Will health insurance cover transition-related care?
- Are there resources that can offer TGNC patients and health providers more support and information?
A: Yes, transgender people are protected from many forms of health-related discrimination.
The Affordable Care Act of 2010 prohibits sex discrimination in federally funded health care facilities, and in 2012 the federal Department of Health and Human Services clarified that this includes discrimination based on transgender status. The Act also forbids insurance providers from refusing to cover a person based on a pre-existing condition, including being transgender. (This part goes into effect in 2014 for those over 18; it’s already law for those under.)
Health care discrimination based on gender identity or expression is also barred if you live in a jurisdiction that has a law that prohibits discrimination on the basis of sex, gender identity or gender expression in public accommodations.
Every state has an agency that licenses or investigates the conduct of health care professionals, and mistreating someone for being transgender certainly falls under the category of misconduct.
Finally, you are protected under the standards promulgated by the Joint Commission, an independent non-profit that accredits thousands of hospitals and other health care organizations throughout the United States. In 2011, the Commission changed its standards to require hospitals to adopt policies prohibiting discrimination based on gender identity or expression. These are voluntary standards, but certification by the Joint Commission is widely recognized as a mark of quality.
A: Yes, the federal Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of all personally identifiable patient information, including your transgender status, your birth-assigned sex or details about your anatomy. This information cannot be shared without your consent, not even to your family and not even to medical personnel unless it is required by your treatment or for the purposes of payment or health care operations (such as inquiries about liability insurance).
- If you experience health care discrimination based on your gender identity or expression, consider filing a complaint. One option is to file a complaint with the federal Department of Health and Human Services’ (HHS) Office for Civil Rights. Find out more about that here: www.hhs.gov/ocr/office/file/index.html.
- Another option is to contact the agency in your state that monitors professional misconduct. In New York, for example, that’s the Health Department’s Office of Professional Misconduct; in California, contact the Medical Board of California.
- If your state, county or city has a law barring discrimination on the basis of sex, gender identity or gender expression in public accommodations, you may file a complaint about the discrimination you have experienced. It’s generally recommended that you consult a lawyer in such a case.
- Or contact Lambda Legal’s Help Desk (toll-free: 866-542-8336 or www.lambdalegal.org/help), which takes calls from TGNC people who have experienced discrimination.
A: The Gay & Lesbian Medical Association (GLMA) maintains an online database at www.glma.org where patients can search for a health care provider by zip code. National Coalition for LGBT Health (wwwlgbthealth.net) member organizations can help too. There are some local directories as well: For instance, the New York Association for Gender Rights Advocacy (NYAGRA) has a “Transgender Health Care Provider Directory” that lists trans-friendly New York City physicians, psychologists, and therapists in a variety of medical fields (http://bit.ly/YBYuFZ)
Another way to find transgender-friendly health care providers is to contact facilities such as
- Fenway Health in Boston
- The Fenway Institute in Minnesota
- Whitman Walker clinic in Washington, DC
- Howard Brown in Chicago
- Lyon Martin in San Francisco
- the LA Gay and Lesbian Center in Los Angeles
- Callen Lorde in New York City
A: No, you do not. A popular myth about transgender health care (and a handy excuse for negligence) is that you need to be a specialist of some kind to treat transgender people. But the truth is that most doctors are fully capable of providing care for transgender patients, whether for routine checkups; treatment of health problems; or transition-related hormone therapy. The World Professional Association for Transgender Health (WPATH) affirmed in 2012 that “Many of the screening tasks and management of co-morbidities associated with long-term hormone use… fall more uniformly within the scope of primary care rather than specialist care, particularly in locations where dedicated gender teams or specialized physicians are not available.”
A: The University of California at San Francisco’s Center of Excellence for Transgender Health in 2011 compiled a Protocol for Transgender Patient Care that doctors of all kinds can use as a reference. The Protocol can be viewed online at http://transhealth.ucsf.edu/trans?page=protocol-00-00. You can also encourage your provider to contact one of the trans-friendly health clinics mentioned above.
A: Absolutely. Transgender people so often experience discrimination or incompetence when they go to the doctor that many feel uncomfortable seeking the range of health care that they need. This includes check-ups for cancer prevention such as pap tests for transgender men, for instance, or prostate exams for transgender women.
Insurance coding systems that cover certain medical treatments only for one gender or the other also create barriers to care. For example, carriers typically deny uterine fibroid treatment to transmen who are enrolled as male.
Doctors’ offices and insurance policies should offer “complete” health care, “regardless of the patient’s self-description or identification, presenting gender, or legal status,” as the Center of Excellence for Transgender Health recommends. The best advice: If you have it, check it!
A: There is continued reluctance among most insurance companies to cover transition-related health care such as hormone therapy or sex reassignment surgery (SRS), which can put these treatments out of reach even when a doctor affi rms they are medically necessary for a particular patient. (To see our FAQ about access to transition-related care, click here.)
The insurance landscape is gradually changing, however, with a growing number of U.S. localities removing such exclusions for their employees (including San Francisco since 2001; Portland, Oregon; Multnomah County, Oregon; Seattle and Minneapolis). And the trend in private workplaces is such that companies hoping to score 100% on the Human Rights Campaign’s annual Corporate Equality Index must now offer trans-inclusive health insurance.
Lambda Legal and other legal advocates are challenging discriminatory exclusions of transgender health care in the courts.
A: These publications are helpful for patients and providers alike:
- Health Care Rights and Transgender People, National Center for Transgender Equality, http://bit.ly/YRAT4t
- Medicare Benefits and Transgender People, National Center for Transgender Equality, http://bit.ly/Xg1V0q
- NYC-Metro Area Transgender and Gender Non-Conforming (TGNC) Resource Guide, Callen-Lorde Community Health Center, http://bit.ly/WMX6NY
- Primary Care Protocol for Transgender Patient Care, Center of Excellence for Transgender Health, http://bit.ly/kaFC4C
- Transgender Health and the Law: Identifying and Fighting Health Care Discrimination, Transgender Law Center, http://bit.ly/11asM3l
- Transgender Inclusive Benefits for Employees and Dependents, Human Rights Campaign, http://bit.ly/TGtO3B
- Understanding the T in LGBT: A Role for Clinicians, The Fenway Institute, www.thefenwayinstitute.org
FOR MORE INFORMATION: Contact Lambda Legal at 212-809-8585, 120 Wall Street, Suite 1900, New York, NY 10005-3904. If you feel you have experienced discrimination, call our Help Desk toll-free at 866-542-8336 or go to www.lambdalegal.org/help.