FEDERAL POLICY UPDATE: LGBTQ HEALTH Kellan Baker, MPH, MA February 5, 2016

Three Hot Topics in LGBTQ Health Policy 1.Nondiscrimination 2.Insurance Market Reforms 3.Data Collection

Nondiscrimination

How many provisions of the Affordable Care Act (statute or regulations) deal with discrimination against LGBT people? A. None B. Two C. Four

LGBT Nondiscrimination in the Affordable Care Act ACA Section 1557 – Health system nondiscrimination PHSA Section 2702 – Guaranteed issue ACA Section 1302 – Essential Health Benefits ACA Section 1311 – Qualified Health Plans & Marketplaces

ACA Section 1557 Civil Rights Act Race, color, national origin Rehabilitation Act Disability HIV/AIDS status Age Discrimination Act Title IX Sex Gender identity and sex stereotyping

“I understand that under federal law, discrimination is not permitted on the basis of race, color, national origin, sex, age, sexual orientation, gender identity, or disability. I can file a complaint of discrimination by visiting

ACA Section 1557 Proposed Rule Bans discrimination on the basis of sex, including gender identity and sex stereotyping Requires coverage for and provision of medically necessary services for trans people Requires trans people to be treated in accordance with their gender identity in, e.g., hospital room assignments Plans must cover preventive services regardless of gender or gender identity Bans categorical transgender insurance exclusions

Insurance Market Reforms

Plans must abide by LGBT-inclusive nondiscrimination requirements ACA Section 1557 Qualified Health Plan regulations Essential Health Benefit regulations Plans must cover preventive services regardless of gender, gender identity, or gender on an ID or in a medical record Plans must offer identical coverage to same- and different-sex spouses Same-sex spouses are considered legally married for purposes of Medicaid eligibility

Removing Trans Exclusions from Medicaid Source: Movement Advancement Project

Data Collection There are at least 4 broad areas of LGBT health data collection: 1.Research 2.Population Surveys 3.Administrative and Program Data 4.Electronic Health Records HHS and the White House have both convened LGBT data collection working groups

Major Opportunities Does your state’s Healthy People plan include LGBT communities? Do your state’s BRFSS, YRBS, and other health surveys include sexual orientation and gender identity (SOGI) questions? Does your state’s Marketplace (including HealthCare.gov) include SOGI questions? Do universities and service organizations in your area include LGBT communities in their research work? Do local hospitals and other health care providers collect SOGI data in their records and forms?

Gender Identity Data Collection Standard (these questions must be asked together!) 1. What is your current gender identity? □ Male □ Female □ Transgender 2. What sex was listed on your original birth certificate? □ Male □ Female □ Don’t know

Data Collection Resources SMART report (Williams Institute, 2009) GenIUSS report (Williams Institute, 2014) Electronic health records data collection (2015):

Thank you! Kellan Baker