updated 10-21-2019

Health Care

The LGBTQ+ community is under attack by the Trump Administration—especially when it comes to health care.

On May 24, the Trump Administration released a proposed rule that would roll back the Health Care Rights Law, a provision in the Affordable Care Act that protects LGBTQ+ patients from discrimination in health insurance and health care. If finalized, this rule would be particularly harmful to transgender and non-binary folks who already face intense discrimination and barriers to health care.

You are still protected. Despite what the Trump administration says, the law has not changed. This is only the announcement of a proposed rule change. Nothing is changing right now. You can still expect to be treated fairly and are protected from discrimination in health insurance and health care.

We still have state-based protections in Massachusetts. The proposed rule will not undermine protections for LGBTQ+ people that exist under state law. The Massachusetts Division of Insurance (DOI) and MassHealth require insurance coverage of medically necessary gender-affirming services. Additionally, our non-discrimination laws will continue to protect access to public accommodations for trans and gender non-conforming people. The Section 1557 rule will not affect our state laws. Click here for MassHealth’s gender affirming surgery guidelines.

What can you do? The period for public comment is over, but you can still weigh in with your concerns about this proposal. The Trans Health Coalition is working to ensure that MA insurance companies adhere to state protections and requirements, regardless of the outcome of the ruling. We are collecting stories of folks who have had trouble obtaining coverage for medically necessary gender-affirming care, been denied coverage for procedures (including scrotoplasty, malar augmentation, and breast augmentation) or denied coverage of procedures that were available to people who do not have gender dysphoria, but were excluded for those who do. To share your story, email TreAndreValentine@masstpc.org. Read Rowan’s story.

U.S. Patient Protection and Affordable Care Act

According to the U.S. Dept. of Health and Human Services (HHS), the Affordable Care Act protects against discrimination based on gender identity. HHS has clarified that sex-based discrimination, which is prohibited by the Patient Protection and Affordable Care Act (ACA), includes discrimination on the basis of gender identity and sex stereotypes. Furthermore, HHS has made clear this includes discrimination against trans people and discrimination based on a provider’s perception of how “masculine” or “feminine” a client’s presentation is.

  • Over twenty-seven percent (27%) of trans/gender non-conforming people have been denied health care.
  • Nearly twenty-one percent (21%) of trans people report being subjected to harsh or abusive language from a health care professional.
  • Over twenty percent (20%) of trans people have been blamed by health care professionals for their own health care conditions.
  • Trans people report the highest rates of discrimination and barriers to care among LGBT people.

HIV Care-related Resources

This is a non-comprehensive list of HIV care related resources in Massachusetts:

HIV Prevention: Pre-Exposure Prophylaxis (PrEP)

Massachusetts HIV/AIDS Services and Resource Guide
(MA Department of Public Health, last updated 2017)

AIDS Action Committee (part of Fenway Health)
(Greater Boston Area)

Fenway Health HIV/AIDS Resources
(Greater Boston Area)

HIV Drug Assistance Program (HDAP)
(Located in Boston but provides services statewide)

Boston Health Care for the Homeless HIV Care
(Greater Boston Area)

A Positive Place (part of Cooley Dickinson Healthcare)
(Northampton)

Problems with Access to Health Care in Massachusetts

Trans people in Massachusetts cite two main problems with accessing health care.

1. Locating providers who are knowledgeable about trans people and health issues

  • Trans people who do not live in urban areas have greater difficulty accessing health care because they often have to drive to Boston, which can be prohibitively inconvenient.
  • Referrals within the health care system can be problematic for trans patients because often isn’t possible to determine how safe or trans-friendly a new provider is.
  • An adult trans man who followed up on a referral for surgery said‚ “I assumed that since I was at [a trans-friendly medical center] it would be fine, and I had [had] other
    surgery there that was absolutely wonderful. He asked about the scars on my chest [from reconstructive surgery], and when I told him what they were, his mouth dropped open and bounced off the floor, and he said, ‘What are you talking about?’ That was it. I was packed up and went away.”
  • Regardless of their ability to find appropriate health care providers, trans individuals still face problems securing access to needed health care, like being turned away from emergency rooms.

2. Securing and paying for needed services

  • Trans people say that they are afraid to disclose their trans identity to insurers, for fear of facing exclusion in or loss of their health care coverage.

Even at the level of paperwork, standard forms can be barriers to health care for trans individuals because they often only say “male” or “female”, which intimidating for any gender non-conforming person and explicitly excludes non-binary-identified trans people.

Resources

The National Center for Transgender Equality has put together a great resource on Health Care Rights and Transgender People, which lists which laws protect trans access to health care, how to report rights violations, and additional resources.

In Changing the Game: What Health Care Reform Means for Gay, Lesbian, Bisexual, and Transgender Americans, the Center for American Progress has compiled important information regarding the state of health care in the United States, how the Affordable Care Act benefits LGBT! people, and action items to ensure the law is fully enacted in every state.

Fenway Transgender Health Services provides “primary medical and mental health care, and supportive services, that is are sensitive to the needs of people who identify on the transgender spectrum.”

The World Professional Association for Transgender Health‘s mission is “to promote evidence based care, education, research, advocacy, public policy, and respect in transgender health.”

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults

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