Are There Federal Programs That Support Gender Affirming Care? Navigating the Policy Landscape

Recent years have seen a surge in state-level actions aimed at restricting access to gender affirming health care for LGBTQ+ youth. States like Alabama, Arkansas, Texas, and Arizona have enacted policies designed to limit this care, although legal challenges have temporarily blocked enforcement in AL, AR, and TX. In 2022 alone, numerous states considered similar legislation. Conversely, some states have moved to protect LGBTQ+ individuals through broad non-discrimination health policies encompassing gender identity and sexual orientation. The Biden administration has also voiced strong opposition to restrictive state policies, emphasizing the importance of eliminating barriers to healthcare for LGBTQ+ people. This raises a critical question for many seeking to understand the current landscape: Are There Any Federal Programs That Support Gender Affirming Care?

This analysis delves into the existing federal and state policies concerning gender affirming services for young people and explores the implications of these diverging state laws.

Table 1: Understanding Key Terms
Gender Identity
Transgender
Gender Dysphoria
Gender Affirming Care

State-Level Restrictions on Youth Access to Gender Affirming Care: A Closer Look

As highlighted, several states have recently implemented or attempted to implement policies that restrict youth access to gender affirming care. These measures sometimes include penalties for adults who assist young people in accessing this care. While court orders have temporarily halted the enforcement of these laws in Alabama, Arkansas, and Texas, the legislative push continues.

Since the beginning of 2022, a significant number of states – 15 in total – have introduced 25 bills aimed at limiting access to gender-affirming care for minors. The specifics of these bills vary widely, but common provisions include:

Criminalization and Professional Penalties: Some bills seek to criminalize or impose professional sanctions on healthcare providers who offer gender affirming care to minors. This can range from disciplinary actions to the revocation of medical licenses, with some bills even equating these services to child abuse.
Parental Penalties: Certain legislation aims to penalize parents who support their children in accessing gender affirming care.
Civil Liability: Some bills propose allowing individuals to sue healthcare providers for damages if they violate these restrictive laws.
Insurance and Funding Restrictions: Other measures seek to limit or prohibit insurance coverage for gender affirming services, or to ban the use of state funds for such care.

Beyond these direct restrictions on healthcare, other state policies indirectly impact access and well-being for transgender youth. “Bathroom bills,” for example, restrict access to bathrooms and locker rooms based on sex assigned at birth. Florida’s “Don’t Say Gay” bill, prohibiting classroom discussions on sexual orientation and gender identity, and laws limiting transgender students’ participation in sports, further contribute to a non-affirming environment. While not directly health policies, these measures can significantly harm the mental health and well-being of LGBTQ+ individuals. Research has shown a direct link between discriminatory policies and increased mental distress among sexual minorities. For instance, a study highlighted that laws allowing denial of services to same-sex couples correlate with increased mental health challenges for sexual minority adults. Furthermore, Florida has issued non-binding guidance advising against gender affirming care for youth, adding another layer of restriction.

State-Level Protections: Safeguarding LGBTQ+ Healthcare Access

While some states are enacting restrictions, others are taking steps to protect LGBTQ+ individuals in healthcare. These states have implemented policies that, while not always specific to youth gender affirming care, create a more inclusive healthcare environment. These protections include:

Health Insurance Non-Discrimination: Prohibiting health insurance discrimination based on sexual orientation and gender identity ensures fairer access to coverage.
Medicaid Coverage for Gender Transition Services: Some states mandate that their Medicaid programs explicitly cover health services related to gender transition, improving access for low-income individuals.

Federal Policy and Gender Affirming Care: Federal Support and Protections

Addressing the central question, are there any federal programs that support gender affirming care? The answer is yes, the federal government, particularly under the Biden administration, has taken significant steps to promote access to healthcare for LGBTQ+ individuals and to combat discrimination based on sexual orientation and gender identity. While there isn’t a single, standalone “federal program for gender affirming care,” federal law and agency interpretations provide crucial support and protection. Key actions include:

HHS and Section 1557 of the ACA: The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) plays a pivotal role. In May 2021, HHS announced that it would interpret and enforce Section 1557 of the Affordable Care Act (ACA) to include gender identity and sexual orientation as protected categories under the prohibition of sex discrimination. Section 1557 is the ACA’s primary non-discrimination provision, applying to a wide range of healthcare entities and programs receiving federal funding. This announcement was a reversal of the Trump administration’s policy and expanded upon the Obama administration’s stance. While legal challenges and injunctions have occurred, the Biden administration is expected to further solidify these protections through implementing regulations. This means that entities receiving federal funds cannot discriminate based on gender identity or sexual orientation, which extends to gender affirming care.
Enforcement and Complaint Process: The OCR actively enforces these federal laws. Guidance from the administration clarifies that parents or caregivers who believe their child has been denied healthcare, including gender affirming care, and healthcare providers facing unlawful restrictions in providing such care, can file administrative complaints with the OCR for investigation. This provides a federal avenue for recourse against discriminatory practices.

In essence, while there isn’t a dedicated grant program specifically labeled “federal gender affirming care program,” federal law and its interpretation prohibit discrimination in healthcare based on gender identity and sexual orientation. This protection, enforced by HHS and OCR, acts as a crucial mechanism to ensure access to gender affirming care within federally funded healthcare systems and programs.

The Medical Consensus: Major Medical Societies on Gender Affirming Care

Adding further weight to the argument for access to gender affirming care is the overwhelming consensus within major medical societies. Leading organizations in pediatrics, endocrinology, psychiatry, and psychology have issued statements affirming the medical necessity and appropriateness of gender affirming care for youth. These societies consistently emphasize the detrimental effects of denying access to these services. Notable statements come from:

These organizations, among many others, have explicitly voiced their support for gender affirming care, often in direct response to restrictive legislation in states like Arkansas and Texas. Furthermore, 23 medical associations jointly filed amicus briefs in legal challenges against these state policies, arguing that denying gender affirming care would irreparably harm young people’s health and force providers to choose between patient well-being and potential legal penalties.

The Endocrine Society’s clinical practice guidelines and the World Professional Association for Transgender Health’s standards of care further solidify gender affirming care as the established standard of care for treating gender dysphoria.

The Far-Reaching Implications of Access Restrictions

Policies restricting youth access to gender affirming care have profound consequences for LGBTQ+ youth, their families, healthcare providers, and communities:

LGBTQ+ Youth: LGBTQ+ youth already face disproportionately higher rates of mental health challenges, including depression, anxiety, and suicidality. Studies from the CDC and others consistently show that transgender youth report significantly higher rates of suicide risk compared to their cisgender peers. Denying access to gender affirming care, such as puberty suppressors and hormone therapy, has been linked to worsened mental health outcomes, including increased suicidal ideation. Conversely, access to this care is associated with improved mental health and overall well-being. Therefore, policies that restrict or prohibit gender affirming care can have severe and potentially life-threatening consequences for young people. Furthermore, negative experiences within the healthcare system are already more common for LGBTQ+ individuals. Barriers to gender affirming care can further erode trust and create additional challenges in accessing necessary medical services. The stress and fear induced by policies like the Texas directive, which threaten families and providers with penalties, can inflict secondary trauma on youth, knowing their pursuit of care could place their loved ones at risk.

Parents: In states with restrictive bills, parents who seek evidence-based gender affirming care for their children may face legal penalties. The Texas directive, for example, classifying gender affirming care as child abuse, could lead to parents losing custody of their children. This creates an agonizing dilemma for parents, forcing them to choose between supporting their child’s healthcare needs and facing potential legal repercussions, or denying care to protect their family from investigation and separation. Either path presents significant trauma for the family, particularly for the young person.

Providers: Healthcare providers are placed in an untenable position, torn between their professional obligation to provide the best possible care and the threat of state sanctions. Directives like the one in Texas can violate patient confidentiality and professional ethics, as highlighted by the American Psychological Association. Providers may be forced to choose between adhering to the standard of care and potentially facing penalties, or withholding necessary care and violating their ethical and professional responsibilities. The Biden administration has affirmed that HIPAA regulations protect patient privacy regarding gender affirming care, but complying with HIPAA may still leave providers vulnerable to state sanctions under conflicting directives.

Teachers and Others: The reach of these restrictive policies can extend beyond healthcare settings. In Texas, mandated reporters, such as teachers, could face penalties for failing to report youth accessing gender affirming care. The directive even suggests that “members of the general public” could face similar reporting requirements and criminal penalties, potentially casting a wide net of surveillance and fear across communities.

The Path Forward: Navigating a Shifting Landscape

The legal and policy environment surrounding youth access to gender affirming care remains dynamic and contested. While numerous states are pursuing restrictions, these efforts are frequently challenged legally and stand in opposition to federal law and policy. Court decisions temporarily blocking enforcement in Alabama, Arkansas, and Texas underscore the ongoing legal battles and the potential for federal protections to prevail.

Looking ahead, it is crucial to monitor the progress of state bills still under consideration and the final outcomes of legal cases in Alabama, Arkansas, and Texas. These decisions will significantly shape the intersection of state and federal policies, including Section 1557’s non-discrimination provisions, federal disability protections, HIPAA patient privacy rules, and the ethical standards of healthcare professionals. Understanding these evolving dynamics is essential for ensuring equitable access to healthcare for all young people, including transgender and gender-diverse youth, and for clarifying the crucial role of federal programs and policies in supporting gender affirming care.

Endnotes

Topics

Health Equity
Health Policy
LGBTQ Health
Children’s Health