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Sexual Orientation Policy Tally

The term “sexual orientation” is loosely defined as a person’s pattern of romantic or sexual attraction to people of the opposite sex or gender, the same sex or gender, or more than one sex or gender. Laws that explicitly mention sexual orientation primarily protect or harm lesbian, gay, and bisexual people. That said, transgender people who are lesbian, gay or bisexual can be affected by laws that explicitly mention sexual orientation.

Gender Identity Policy Tally

“Gender identity” is a person’s deeply-felt inner sense of being male, female, or something else or in-between. “Gender expression” refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms and speech patterns that can be described as masculine, feminine, or something else. Gender identity and expression are independent of sexual orientation, and transgender people may identify as heterosexual, lesbian, gay or bisexual. Laws that explicitly mention “gender identity” or “gender identity and expression” primarily protect or harm transgender people. These laws also can apply to people who are not transgender, but whose sense of gender or manner of dress does not adhere to gender stereotypes.

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Healthcare Laws and Policies

Insurance non-discrimination laws protect LGBT 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. Prohibitions on transgender exclusions in health insurance benefits bar health insurance issuers from denying or limiting coverage based on gender identity and require the removal of “transgender exclusions” from health plans.
United States Map
Vermont New Hampshire Washington D.C. Maryland Delaware New Jersey Connecticut Rhode Island Massachusetts Alaska Hawaii California Oregon Washington Nevada Utah Arizona Idaho Montana Wyoming Colorado 33 Texas North Dakota South Dakota Nebraska Kansas Oklahoma Minnesota Iowa Louisiana Arkansas Missouri Mississippi Florida Georgia Tennessee South Carolina North Carolina Wisconsin Illinois Michigan Indiana Kentucky Ohio West Virginia Maine New York Pennsylvania Virginia Vermont New Hampshire
  • Transgender exclusions in health insurance service coverage prohibited (20 states + D.C.)
  • Law prohibits health insurance discrimination based on sexual orientation and gender identity (12 states + D.C.)
  • Law prohibits health insurance discrimination based only on gender identity only (2 states)
  • Law prohibits health insurance discrimination based only on sexual orientation only (0 states)
  • No law providing LGBT inclusive insurance protections (36 states)
*Note: New Mexico's Bulletin 2018-013 bans exclusions of transgender-related care. It also prohibits discrimination on the basis of gender identity.

Laws prohibiting discrimination based on sexual orientation and gender identity refer to statewide protections against discrimination in benefits coverage provided by insurance plans to LGBT plan enrollees. Prohibitions on transgender exclusions in health insurance benefits prohibit insurance discrimination against transgender people. These states bar health insurance issuers from denying or limiting coverage based on gender identity and require the removal of transgender exclusions from health plans. New Jersey's nondiscrimination protections only prohibit discrimination based on gender identity and do not mention sexual orientation. For more information, please contact the Center for American Progress.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies." http://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies (date of access). 

Percent of LGBT Population Covered by Laws

37%

37 % of LGBT population lives in states with insurance protections that include sexual orientation and gender identity

3%

3 % of LGBT population lives in states with insurance protections that include only gender identity

0%

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

60%

60 % of LGBT population lives in states that do not have LGBT-inclusive insurance protections

52%

52 % of LGBT population lives in states that prohibit transgender exclusions in health insurance service coverage

State Medicaid policies reflect varying interpretations of federal regulations that prohibit discrimination based on gender identity. Some state Medicaid policies explicitly include health care related to gender transition for transgender people, whereas other state policies explicitly exclude transgender health coverage and care.
United States Map
Vermont New Hampshire Washington D.C. Maryland Delaware New Jersey Connecticut Rhode Island Massachusetts Alaska Hawaii California Oregon Washington Nevada Utah Arizona Idaho Montana Wyoming Colorado 33 Texas North Dakota South Dakota Nebraska Kansas Oklahoma Minnesota Iowa Louisiana Arkansas Missouri Mississippi Florida Georgia Tennessee South Carolina North Carolina Wisconsin Illinois Michigan Indiana Kentucky Ohio West Virginia Maine New York Pennsylvania Virginia Vermont New Hampshire
  • State Medicaid policy explicitly covers health care related to gender transition for transgender people(18 states + D.C.)
  • State Medicaid has no explicit policy regarding transgender health coverage and care (22 states)
  • State Medicaid policy explicitly excludes transgender health coverage and care (10 states)
*Note: In both Iowa and Wisconsin, recent court cases have ruled that the states' exclusion of transgender health coverage violates existing law. In both cases, the judges have required that the state pay for the medical care of transgender plaintiffs, but these cases are still moving through the court and do not yet mean that the states' exclusions have been struck down.

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 it is medically necessary. Second, “blanket bans” on all transition-related care are considered discriminatory, but that doesn’t mean that some transition-related care cannot 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.

Interpretation of federal law as it applies to state Medicaid coverage, as well as state Medicaid law itself, varies from state to state, as this map illustrates. For more information, please contact NCTE or CAP.

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." http://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies (date of access). 

Percent of LGBT Population Covered by Laws

49%

49 % of LGBT population lives in states that explicitly cover health care related to gender transition in Medicaid coverage

38%

38 % of LGBT population lives in states that have no explicit policy regarding transgender health coverage and care in Medicaid coverage

14%

14 % of LGBT population lives in states that explicitly exclude transgender health coverage and care from Medicaid coverage

State laws or administrative policies which provide, or explicitly exclude, transgender state employees access to transgender and transition-related healthcare through their employment health benefits.
United States Map
Vermont New Hampshire Washington D.C. Maryland Delaware New Jersey Connecticut Rhode Island Massachusetts Alaska Hawaii California Oregon Washington Nevada Utah Arizona Idaho Montana Wyoming Colorado 33 Texas North Dakota South Dakota Nebraska Kansas Oklahoma Minnesota Iowa Louisiana Arkansas Missouri Mississippi Florida Georgia Tennessee South Carolina North Carolina Wisconsin Illinois Michigan Indiana Kentucky Ohio West Virginia Maine New York Pennsylvania Virginia Vermont New Hampshire
  • State provides transgender and transition-related healthcare in their state employee health benefits (18 states + D.C.)
  • State does not include transgender and transition-related healthcare in their state employee health benefits (20 states)
  • State explicitly excludes transition-related healthcare in their state employee health benefits (12 states)
*Note: In August 2018, Wisconsin's Group Insurance Board voted to reinstate transition-related care for state employees. Wisconsin had formerly approved these benefits in 2016, but reversed the decision in 2017 at the request of the governor.  Coverage for state workers will resume January 1, 2019.

Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies." http://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies (date of access). 

Percent of LGBT Population Covered by Laws

41%

41 % of the LGBT population lives in states that provide transgender state employees access to transgender and transition-related healthcare through their employment health benefits

38%

38 % of LGBT population lives in states that do not include transgender and transition-related healthcare in their state employee health benefits

21%

21 % of LGBT population lives in states that explicitly excludes transition-related healthcare in their state employee health benefits

Key
  • State has law that only covers sexual orientationLaw covers sexual orientation
  • State has law that covers sexual orientation and gender identityLaw covers sexual orientation and gender identity/expression
  • State has this law Policy includes transgender health care
  • State does not have this law Policy excludes transgender health care
State Private Insurance
Non-Discrimination
Medicaid
Non-Discrimination
Transgender Inclusive Health Benefits for State Employees
  Citations Citations Citations
Alabama
Alaska State does not have this law
Arizona
Arkansas
California
State has law that covers sexual orientation and gender identity
State has this law State has this law
Colorado
State has law that covers sexual orientation and gender identity
State has this law
Connecticut State has this law State has this law
Delaware
State has law that covers sexual orientation and gender identity
State has this law
District of Columbia
State has law that covers sexual orientation and gender identity
State has this law State has this law
Florida
Georgia State does not have this law
Hawaii
State has law that covers sexual orientation and gender identity
State has this law State has this law
Idaho
Illinois
State has law that covers sexual orientation and gender identity
State has this law
Indiana State has this law
Iowa State does not have this law
Kansas
Kentucky State has this law
Louisiana
Maine State does not have this law
Maryland State has this law State has this law
Massachusetts State has this law State has this law
Michigan
Minnesota
State has law that covers sexual orientation and gender identity
State has this law State has this law
Mississippi
Missouri State does not have this law
Montana State has this law State has this law
Nebraska State does not have this law
Nevada
State has law that covers sexual orientation and gender identity
State has this law State has this law
New Hampshire State has this law State has this law
New Jersey
State has law that covers gender identity
State has this law State has this law
New Mexico
State has law that covers gender identity
New York
State has law that covers sexual orientation and gender identity
State has this law
North Carolina
North Dakota
Ohio State does not have this law
Oklahoma
Oregon
State has law that covers sexual orientation and gender identity
State has this law State has this law
Pennsylvania State has this law State has this law
Rhode Island
State has law that covers sexual orientation and gender identity
State has this law State has this law
South Carolina
South Dakota
Tennessee State does not have this law
Texas
Utah
Vermont
State has law that covers sexual orientation and gender identity
State has this law
Virginia
Washington
State has law that covers sexual orientation and gender identity
State has this law State has this law
West Virginia
Wisconsin State does not have this law State has this law
Wyoming State does not have this law
Data current as of 09/19/2018
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