What Laws Protect Me?
The following laws and policies offer protection for transgender people in health care:
- The Affordable Care Act (ACA) prohibits sex discrimination, including discrimination based on gender identity, transgender status, or gender stereotypes, in hospitals and other health programs or facilities receiving federal financial assistance as well as bias based on race, national origin, age, and disability. It prohibits the majority of health insurance companies and health care providers from discriminating against you, including by refusing to cover transition-related treatments or refusing to treat you consistently with your gender identity.Courts and the Department of Health and Human Services have interpreted the law to prohibit discrimination against people who are transgender or who fail to conform to gender stereotypes. Find out more about the ACA means for trans people here.
- The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of individually identifiable health information, including information related to a person’s transgender status and transition. It also gives patients the right to access, inspect, and copy your protected health information held by hospitals, clinics, and health plans.
- Medicare and Medicaid regulations protect the right of hospital patients to choose their own visitors and medical decision-makers regardless of their legal relationship to the patient. This means that hospitals cannot discriminate against LGBT people or their families in visitation and in recognizing a patient’s designated decision-maker.
- Joint Commission hospital accreditation standards require hospitals to have internal policies prohibiting discrimination based on gender identity and sexual orientation.
- The Nursing Home Reform Act establishes a set of nursing home residents’ rights that include the right to privacy, including in visits from friends or loved ones; the right to be free from abuse, mistreatment, and neglect; the right to choose your physician; the right to dignity and self-determination; and the right to file grievances without retaliation.
- State and local nondiscrimination laws prohibit health care discrimination against trans people in many circumstances. A large number of states also have explicit policies that prohibit discrimination against trans people, like exclusions of transition-related care, in private insurance and Medicaid. Find out more about state health insurance policies here.
What Are My Healthcare Rights?
What are my rights in health insurance?
The Affordable Care Act prohibits most health insurers from discriminating based on gender identity and transgender status. Insurance companies that receive federal funding or that have one or more plans on a federal or state Marketplace have to comply with this requirement. That includes all major insurance companies and the majority of smaller insurance companies, but some small health insurance companies may not be covered.
Here are some policies or practices that would be illegal under the ACA:
- Excluding transition-related care from coverage: Insurance companies can’t have automatic or categorical exclusions of transition-related care. For example, an insurance company that says that all care related to gender transition is excluded violates the ACA. An insurance company also can’t place limits on the extent or conditions of coverage for transition-related care, such as excluding a specific procedure, if those limits are discriminatory. For example, excluding a specific service for gender transition may be prohibited if that service is covered for individuals with other medical conditions, or if there no legitimate, nondiscriminatory reason for the limitation.
- Refusing to enroll you in a plan, cancelling your coverage, or imposing higher rates for you because of your transgender status: An insurance company can’t treat you differently, refuse to enroll you, or limit coverage for any services based on your transgender status.
- Denying coverage for care typically associated with one gender: It’s illegal for an insurance company to deny you coverage for gender-specific or gender-related services based on your gender as listed in the insurance company’s records or your assigned sex at birth. For example, an insurance company can’t deny a transgender woman coverage for a prostate exam because she is listed as female in her records or coverage for a gynecological care because her sex assigned at birth was male.
It may take time for these rules to be enforced, and we encourage individuals to use their plan’s appeal process if claims are denied, and contact a legal organization if needed.
Which health programs are prohibited from discriminating?
Under the Affordable Care Act, it is illegal for any health program, provider or organization that gets any federal funding (including accepting Medicare or Medicaid payments for any patients) or is administered by a federal agency to discriminate against you because you are transgender, or because you are perceived as not conforming to gender stereotypes. The following are examples of places and programs that may be covered by the law:
- Physicians’ offices
- Community health clinics
- Drug rehabilitation programs
- Rape crisis centers
- Nursing homes and assisted living facilities
- School- and university-based health clinics
- Medical residency programs
- Home health providers
- Veterans health centers
- Health services in prison or detention facilities
What types of discrimination are prohibited by law?
It is illegal for health care providers that receive federal money to do any of the following because you are transgender, or because you are perceived as not conforming to gender stereotypes:
- Refuse to admit or treat you
- Subject you to intrusive and unnecessary examinations as a condition of treatment
- Refuse to provide you services that they provide to other patients
- Refuse to treat you according to your gender identity, including by providing you access to restrooms and other facilities consistent with your gender
- Harass you or refuse to respond to harassment by staff or other patients
- Refuse to provide counseling, medical advocacy or referrals, or other support services
- Isolate you or deprive you of human contact, or limit your participation in social or recreational activities offered to others
- Require you to participate in “conversion therapy” for the purpose of changing your gender identity
- Harass, coerce, intimidate, or interfere with your ability to exercise your health care rights
Discrimination based on gender stereotypes include discrimination against lesbian, gay, and bisexual individuals and same-sex couples. The law also prohibits discrimination on the basis of race, color, national origin, age, and disability, including HIV/AIDS status.
What are my rights regarding privacy of my health information?
Patient health information is protected by the Health Insurance Portability and Accountability Act (HIPAA), which applies to most health care providers and to health insurance plans. Information regarding your transgender status, such as your diagnosis, medical history, birth-assigned sex, or anatomy, may constitute protected health information. Such information should not be disclosed to anyone—including family, friends, and other patients—without your consent. This information should also not be disclosed to medical facility personnel unless there is a medically relevant reason to do so. If this information is shared for purposes of gossip or harassment, it is a violation of HIPAA.
Many states have explicitly banned transgender exclusions in most health plans, including some plans that are not covered under federal law.
Can my insurance plan exclude routine tests or other services usually associated with one gender?
No. According to the U.S. Department of Health and Human Services, plans cannot deny coverage for medically appropriate service simply because you are transgender or because of the gender listed in your insurance record. Denials like this can often be resolved through an appeal with the plan.
What Can I Do About Discrimination?
Filing a complaint of health care discrimination with the HHS Office for Civil Rights
If you have experienced one or more of the forms of discrimination described above, you may file a complaint with the HHS Office for Civil Rights (OCR) within 180 days of when you knew the discriminatory action or inaction occurred. OCR also investigates HIPAA privacy violations. Additionally, the person making the complaint doesn’t have to be the person who experienced discrimination. Someone else, like a friend, family member, or local community member, may file a claim on your behalf.
If you are filing a complaint to challenge your insurance company’s coverage denial for transition-related care, or any other coverage denial based on your transgender status or gender identity, it’s recommended, but not required, that you first appeal the denial through your insurance company’s appeal procedure, and file a complaint with OCR if your appeal is rejected. You can find out more about appealing a denial here: https://www.healthcare.gov/appeal-insurance-company-decision/appeals.
Your complaint with HHS OCR must be filed in writing, either electronically or in writing. You can file your complaint electronically through OCR’s complaint portal (https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf). You can find out how to file your complaint in writing and mail, email or fax it here: http://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html.
For HIPAA complaints, you can use HHS’s Health Information Privacy Complaint Form Package (http://www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaintform.pdf).
Your complaint must name the service provider or other organization involved and describe the acts or omissions you believe were discriminatory. If you experienced discrimination because you are LGBT, make sure to mark or write “sex discrimination” on the form. Your complaint will be more effective if you can present solid factual information. Write down the date, time, location, witnesses, and people involved in any events that were discriminatory or disrespectful. Also keep any documents that the discriminating entity gives you. If you present your situation in an organized way, you increase the chance of your complaint getting the attention it deserves.
Once you file a report of discrimination, HHS OCR will contact you to discuss your situation and determine whether the agency can undertake a formal investigation. Based on its findings, OCR may direct the discriminating entity to take appropriate corrective actions, such as changing policies or practices or providing services that were denied to you. A full explanation of the HHS complaint process can be found at: http://www.hhs.gov/ocr/civilrights/complaints/index.html.
The Affordable Care Act also permits you to bring a discrimination lawsuit directly in federal court. You do not need to file a complaint with OCR first to do this. However, a lawsuit can be a lengthy and expensive process, and it will be difficult to succeed without an attorney. Alternatively, if you file a complaint with OCR and the agency does not find reason to believe discrimination occurred, you can later file a lawsuit in federal court.
Other options for filing discrimination complaints
- Hospitals: File a complaint with HHS OCR or the Joint Commission, which accredits most hospitals. You can find more information or submit a complaint online at http://www.jointcommission.org.
- Nursing home, board and care home, or assisted living facility: File a complaint with HHS OCR or contact your local long-term care ombudsman. You can locate an ombudsman here: http://www.ltcombudsman.org/ombudsman.
- Discrimination by employees of the US Department of Health & Human Services: File with HHS OCR or contact the relevant Operating Division’s Equal Employment Opportunity (EEO) Ofﬁce or the Department’s EEO Compliance and Operations Division (http://www.hhs.gov/ocr/civilrights/complaints/index.html).
- Federal Health Employee Benefits Program: File a complaint with the Office of Personnel Management (FEHB@opm.gov) or the Equal Employment Opportunity Commission (https://www.eeoc.gov/federal/fed_employees/complaint_overview.cfm).
- Veterans Health Administration: File a complaint with the Veterans Administration’s External Discrimination Complaints Program or contact a Patient Advocate at your VA Medical Center. Find out more here: http://www.va.gov/orm/ and http://www.va.gov/health/patientadvocate.
- Employee health plan: File a complaint with HHS OCR or with the Equal Employment Opportunity Commission (https://www.eeoc.gov/federal/fed_employees/complaint_overview.cfm).
- TRICARE: File a complaint with HHS OCR or TRICARE (http://tricare.mil/ContactUs/FileComplaint.aspx).
Who Else Can Help Me?
Resolving a case of health care discrimination can be a complicated and stressful process. Don’t hesitate to seek help from a local community organization or an attorney (or both). While NCTE does not provide legal services or referrals, there are many other groups that may give you referrals or maintain lists of local attorneys. You can try your local legal aid or legal services organization, or national or regional organizations such as the National Center for Lesbian Rights, Lambda Legal, the Transgender Law Center, the ACLU, and others listed on NCTE’s website.
How Else Can I Help?
Share your story. If you are facing discriminatory treatment, consider sharing your story with NCTE so we can use it in advocacy efforts to change policy, improve education, and reduce future discrimination. If you successfully resolve a health care situation, and especially if any of the resources here helped, we want to hear about that as well.
FAQ on the Affordable Care Act Nondiscrimination Section
Department of Health and Human Services Office for Civil Rights
HHS Rule on Health Care Discrimination
Links to State and Local Human Rights Agencies:
Links to Legal Service Organizations:
Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies, Lambda Legal, HRC, & New York Bar:
Healthcare Equality Index, Human Rights Campaign
National Center for LGBT Health Education:
National Resource Center on LGBT Aging:
Primary Care Protocols for Transgender Patients, UCSF Center of Excellence for Transgender Health: