Movement Advancement Project | Healthcare Laws and Policies (2023)

Insurance nondiscrimination laws and policies protect LGBTQ people from being unfairly denied health insurance coverage or from being unfairly excluded from coverage for certain health care procedures on the basis of sexual orientation or gender identity. "Bans on transgender exclusions in health insurance" are policies that bar health insurers from explicitly refusing to cover transgender-related health care benefits.

Movement Advancement Project | Healthcare Laws and Policies (1)

Washington New York U.S. Virgin Islands Puerto Rico Guam Commonwealth of the Northern Mariana Islands American Samoa New Hampshire Vermont Virginia Pennsylvania New York Maine West Virginia Ohio Kentucky Indiana Michigan Illinois Wisconsin North Carolina South Carolina Tennessee Georgia Florida Mississippi Missouri Arkansas Louisiana Iowa Minnesota Oklahoma Kansas Nebraska South Dakota North Dakota Texas 33 Colorado Wyoming Montana Idaho Arizona Utah Nevada Oregon California Hawaii Alaska Massachusetts Rhode Island Connecticut New Jersey Delaware Maryland Washington D.C. New Hampshire Vermont
  • Movement Advancement Project | Healthcare Laws and Policies (2)

    Transgender exclusions in health insurance service coverage prohibited (24states+D.C.)

  • Law prohibits health insurance discrimination based on sexual orientation and gender identity (15states,1territory+D.C.)

  • Law prohibits health insurance discrimination based only on gender identity only (7states)

  • Law prohibits health insurance discrimination based only on sexual orientation only (0states)

  • No law providing LGBTQ inclusive insurance protections (27states,4territories)

  • Law explicitly permits insurers to refuse to cover gender-affirming care (1state)


For more information, please contact the Center for American Progress.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies."

https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies. Accessed 11/04/2022.

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

41%

41 % of LGBTQ population lives in states with insurance protections that include sexual orientation and gender identity

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13%

13 % of LGBTQ population lives in states with insurance protections that include only gender identity

0%

0 % of LGBTQ population lives in states with insurance protections that include only sexual orientation

44%

44 % of LGBTQ population lives in states that do not have LGBT-inclusive insurance protections

57%

57 % of LGBTQ population lives in states that prohibit transgender exclusions in health insurance service coverage

1%

1 % of LGBTQ population lives in states that permit insurers to refuse to cover gender-affirming care

Bans on best practice medical care represent one of the most extreme—and coordinated—political attacks on transgender people in recent years. These bills target transgender youth by blocking their access to best practice medical care, care that is backed by years of rigorous research and endorsed by the American Academy of Pediatrics, the American Medical Association, and other leading health authorities. These bills not only display a fundamental lack of understanding of transgender children, but they also ban access to medical care often by criminalizing either the doctors or even the parents of transgender youth seeking to provide best practice medicine for children in their care. For more on these efforts,read MAP's 2021 spotlight report.

Movement Advancement Project | Healthcare Laws and Policies (3)

  • State law bans or restricts best practice medical care for transgender youth (see note)(3states)

  • State does not ban best practice medical care for transgender youth (47states,5territories+D.C.)

  • Movement Advancement Project | Healthcare Laws and Policies (4)

    State ban makes it a felony crime to provide best practice medical care for transgender youth(1state)

  • Movement Advancement Project | Healthcare Laws and Policies (5)

    State executives have attempted to limit or restrict medical care for transgender youth, but state law does not ban this care (see note)(2states)

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*Notes (and see "Citations & More Information" below the map legend for more information about every state):
-Alabama: In May 2022, a federal judgetemporarily blockedthe part of the state's law that bans medication for transgender youth, though the rest of the law remains in effect for now, including the felony punishment and provisions that require school staff to tell parents if a child expresses thoughts that they might be transgender.
-Arizona: The state's law (SB1138, 2022) does not go into effect until March 2023. The law bans gender-affirming surgical care for minors, though it does not ban other forms of best-practice medical care such as hormone-related medication.
-Arkansas:In July 2021, a federal judgetemporarily blockedArkansas's law from going into effect. This map will be updated as that case progresses.
-Tennessee: The state's law (SB126, 2021) prohibits medical providers from providing hormone-related medication to "prepubertal minors" (emphasis added). Best practice medical care for transgender youth only includes such medication once a youth has entered puberty, not prior to it, and this further illustrates how these legislative efforts reflect a fundamental lack of understanding of medical care for transgender youth. However, this legislation sets a dangerous precedent for further restrictions on medical care for transgender youth.
-Texas:As reported by Equality Texas, "On February 18th [2022], in the middle of early voting for the Texas primary elections, Attorney General Ken Paxton released a non-binding opinion grossly mischaracterizing medically necessary, best-practice healthcare for transgender children as child abuse. Shortly after, Governor Abbott sent a letter to the Department of Family Protective Services (DFPS) directing them to enforce Paxton’s opinion." These actions do not change the law in Texas and are not legally binding (in fact, their very legality is being directly challenged in court), but they have nonetheless caused harm and even initiated investigations into families of transgender children in the state. These investigations were temporarily halted by a statewide injunction, until a Texas Supreme Court ruling in May 2022 ended that injunction. However, the Texas Supreme Court also ruled that the governor had no authority to order such investigations. This map will be updated as this case progresses. For more information and resources, see theTransgender Education Network of Texas (TENT)andEquality Texas.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies."https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies. Accessed 11/04/2022.

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

4%

4 % of LGBTQ population lives in states that ban or restrict best practice medical care for transgender youth (see note beneath map)

96%

96 % of LGBTQ population lives in states that do not ban best practice medical care for transgender youth

Movement Advancement Project | Healthcare Laws and Policies (6)

8%

8 % of LGBTQ population lives in states where state executives have attempted to limit or restrict best practice medical care for transgender youth, but state law does not ban this care (see note beneath map)

State Medicaid policies reflect varying interpretations of federal regulations that prohibit discrimination based on gender identity. Some state policies explicitly say that the state's Medicaid program covers medically necessary care for transgender people, whereas other state policies explicitly exclude such care. Still other states have no explicit policy either way. Importantly, even in states without an explicit policy, transgender people may still be able to access transgender-inclusive coverage or benefits. However, when states have no explicit policy, transgender people are more likely to report obstacles to receiving care, including being denied needed care.

Movement Advancement Project | Healthcare Laws and Policies (7)

  • State Medicaid policy explicitly covers health care related to gender transition for transgender people(26states,1territory+D.C.)

  • State Medicaid has no explicit policy regarding transgender health coverage and care (15states,4territories)

  • State Medicaid policy explicitly excludes transgender health coverage and care (9states)

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*Notes (see also the "Citations & More Information" link below the map legend for more info about every state):
--Arkansas'HB1570(2021)banned best-practice medical care for transgender youth, and it also explicitly prohibited the state Medicaid policy from covering gender-affirming care for minors. See the state-by-state statutes for more detail on the law's other implications.
--Hawai`i is currently shaded as beige due to the current uncertainty of access in the state. The state has a 2016 law banning gender identity discrimination in health insurance, but the state also has a pre-existing regulation that explicitly excludes gender-affirming health care from being covered or paid for by the state Medicaid program. As a result, the current ability of transgender Hawaiians to access gender-affirming care through Medicaid is uncertain.
--Ohio policy explicitly excludes transgender-related care, but as of mid-2019, The Washington Post and Bloomberg News both report that state officials say they are not enforcing the exclusion.
--In Louisiana and Utah, the states have no explicit policy, but TLDEF reports that the individual health organizations that operate Medicaid in the state each have inclusive policies for covering transgender-related care.

For further information and details, please also visit theTransgender Legal Defense & Education Fund (TLDEF)'s Trans Health Projectresources and research.

Federal law prohibits discrimination in health care on the basis of gender identity. Under Section 1557 of the Affordable Care Act (ACA), health facilities, programs, and activities receiving federal funding may not deny insurance coverage or care on the basis of, among other things, sex and gender identity and expression. This means several things for transgender people. First, sex-specific care cannot be denied simply because someone identifies as another gender. For example, a transgender man could not be denied care for ovarian cancer if such care is medically necessary. Second, “blanket bans” on all transition-related care are considered discriminatory, though some transition-related care can still be denied on a case-by-case basis. Finally, transition-related care that would be approved were it not related to transition cannot be denied.

If you have experienced discrimination in health care, you can file a complaint with the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services within 180 days of when the discrimination occurred. OCR also investigates violations involving the improper disclosure or use of your private medical information.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies." https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies. Accessed 11/04/2022.

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

58%

58 % of LGBTQ population lives in states that explicitly cover health care related to gender transition in Medicaid coverage

16%

16 % of LGBTQ population lives in states that have no explicit policy regarding transgender health coverage and care in Medicaid coverage

26 % of LGBTQ population lives in states that explicitly exclude transgender health coverage and care from Medicaid coverage

This map reflects state laws or administrative policies which explicitly include, explicitly exclude, or have no clear policy covering transition-related or gender-affirming care for transgender people who are state employees as part of their state employee health benefits.

Movement Advancement Project | Healthcare Laws and Policies (8)

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  • State explicitly includes gender-affirming care in its state employee health benefits (24states+D.C.)

  • State does not mention or has no clear policy regarding gender-affirming care in its state employee health benefits (11states,5territories)

  • State explicitly excludes gender-affirming care from its state employee health benefits (15states)


*Green states with an asterisk cover gender-affirming care but may require preauthorization or pre-approval for receiving it.
*Oklahoma has multiple plans available to state employees. According to
TLDEF's research, two of these plans have explicit exclusions; one has no policy either way; and one has no policy, but the provider (Blue Cross) has its own policy that includes gender-affirming care. However, because this is a Blue Cross policy and not an Oklahoma policy, and the state has multiple other plans with exclusions, Oklahoma is coded here as having exclusionary plans. Please see TLDEF's research for more detail, or click "Citations & More Information" beneath the map legend for more detail about every state.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies." https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies. Accessed 11/04/2022.

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

56%

56 % of the LGBTQ population lives in states that explicitly include gender-affirming care in its state employee health benefits

13%

13 % of LGBTQ population lives in states that do not mention or has no clear policy regarding gender-affirming care in its state employee health benefits

31%

31 % of LGBTQ population lives in states explicitly exclude gender-affirming care from its state employee health benefits

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  • Movement Advancement Project | Healthcare Laws and Policies (12) Bans insurance exclusions of transgender health care
  • State does not have this law Bans best practice medical care for transgender youth
  • State has this law Policy includes transgender health care
  • State does not have this law Policy excludes transgender health care
State Private InsuranceNondiscrimination Bans on Medical Care for Transgender Youth Medicaid Transgender Inclusive Health Benefits for State Employees
Citations Citations Citations Citations
Alabama State does not have this law
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American Samoa
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California

Movement Advancement Project | Healthcare Laws and Policies (13)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (14)
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Colorado

Movement Advancement Project | Healthcare Laws and Policies (15)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (16)
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Connecticut

Movement Advancement Project | Healthcare Laws and Policies (17)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (18)
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Delaware

Movement Advancement Project | Healthcare Laws and Policies (19)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (20)
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District of Columbia

Movement Advancement Project | Healthcare Laws and Policies (21)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (22)
State has this law State has this law
Florida State does not have this law State does not have this law
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Guam
Hawaii

Movement Advancement Project | Healthcare Laws and Policies (23)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (24)
State has this law
Idaho State has this law
Illinois

Movement Advancement Project | Healthcare Laws and Policies (25)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (26)
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Indiana State has this law
Iowa State has this law
Kansas State has this law
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Maine

Movement Advancement Project | Healthcare Laws and Policies (27)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (28)
State has this law State has this law
Maryland Movement Advancement Project | Healthcare Laws and Policies (29) State has this law State has this law
Massachusetts

Movement Advancement Project | Healthcare Laws and Policies (30)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (31)
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Michigan

Movement Advancement Project | Healthcare Laws and Policies (32)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (33)
State has this law
Minnesota

Movement Advancement Project | Healthcare Laws and Policies (34)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (35)
State has this law State has this law
Mississippi State does not have this law
Missouri State does not have this law
Montana Movement Advancement Project | Healthcare Laws and Policies (36) State has this law State has this law
Nebraska State does not have this law State does not have this law
Nevada

Movement Advancement Project | Healthcare Laws and Policies (37)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (38)
State has this law State has this law
New Hampshire

Movement Advancement Project | Healthcare Laws and Policies (39)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (40)
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New Jersey

Movement Advancement Project | Healthcare Laws and Policies (41)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (42)
State has this law State has this law
New Mexico

Movement Advancement Project | Healthcare Laws and Policies (43)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (44)
New York

Movement Advancement Project | Healthcare Laws and Policies (45)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (46)
State has this law State has this law
North Carolina State has this law
North Dakota State has this law State does not have this law
Northern Mariana Islands
Ohio State does not have this law State does not have this law
Oklahoma State does not have this law
Oregon

Movement Advancement Project | Healthcare Laws and Policies (47)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (48)
State has this law State has this law
Pennsylvania

Movement Advancement Project | Healthcare Laws and Policies (49)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (50)
State has this law State has this law
Puerto Rico

Movement Advancement Project | Healthcare Laws and Policies (51)

State has law that covers sexual orientation and gender identity
State has this law
Rhode Island

Movement Advancement Project | Healthcare Laws and Policies (52)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (53)
State has this law State has this law
South Carolina
South Dakota State does not have this law
Tennessee State does not have this law State does not have this law
Texas State does not have this law State does not have this law
U.S. Virgin Islands
Utah State does not have this law
Vermont

Movement Advancement Project | Healthcare Laws and Policies (54)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (55)
State has this law
Virginia

Movement Advancement Project | Healthcare Laws and Policies (56)

State has law that covers gender identity Movement Advancement Project | Healthcare Laws and Policies (57)
Washington

Movement Advancement Project | Healthcare Laws and Policies (58)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (59)
State has this law State has this law
West Virginia State has this law State does not have this law
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Movement Advancement Project | Healthcare Laws and Policies (60)

State has law that covers sexual orientation and gender identity Movement Advancement Project | Healthcare Laws and Policies (61)
State has this law State has this law
Wyoming

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