1.  ASOs/CBOs have been at the fore of advocating for the health of LGBTQ persons  ASOs/CBOs are culturally competent in terms of LGBTQ issues and well-respected within LGBTQ communities  Well-positioned to assist in enrolling LGBTQ communities into health care coverage In our ASO/CBO Needs Assessment, 80% of respondents said that at least 10% of their clients were gay or bisexual men and 20% of respondents said 10% of their clients were trans women 45% of Ryan White clients in 2013 were gay and bisexual men

2. Kellan Baker, MPH, MA Steering Committee Member, Out2Enroll Senior Fellow, Center for American Progress

3. Kellan E. Baker, MPH, MA Steering Committee Member, Out2Enroll Senior Fellow, Center for American Progress www.Out2Enroll.org

4. Our mission: To connect LGBT people and their families with new affordable coverage options under the ACA. “Be out. Be healthy. Get covered.” Federal Agencies Project

5. www.Out2Enroll.org  Define terms, identities, and concepts associated with LGBTQ communities.  Describe systematic health care access barriers that LGBTQ populations have historically faced, and how ACA is helping address them.  Identify best practices and practical tips for addressing LGBTQ-specific enrollment questions.  Develop skills for enrolling LGBTQ individuals and families effectively.

6. www.Out2Enroll.org  LGBT: Lesbian, Gay, Bisexual, Transgender  Queer: A prideful, reclaimed word some LGBT people use to describe their identity as lesbian, gay, bisexual, and/or transgender.  Sexual orientation: Not just about sexuality or who you are attracted to—also about who you love and who you create a family with. Gay or lesbian Heterosexual or straight Bisexual

7. www.Out2Enroll.org  Gender identity: Each person’s deeply felt, internal knowledge of their own gender.  Transgender: A person whose gender identity is different from that typically associated with their assigned sex at birth.  Trans man: A person who was assigned the female sex at birth but identifies and lives as a man.  Trans woman: A person who was assigned the male sex at birth but identifies and lives as a woman.

8. www.Out2Enroll.org A.Straight B.Transgender C.Heterosexual D.Lesbian

9. www.Out2Enroll.org A.700,000 B.1.3 million C.9 million D.35 million

10. www.Out2Enroll.org Source: www.lgbtmap.org/equality-maps/lgbt_populations

11. www.Out2Enroll.org

13. ↑ Tobacco and other substance use ↑ Mental health concerns, such as depression and suicide attempts ↑ Certain cancers, such as breast cancer ↑ HIV/AIDS ↑ Experiences of bullying and violence Source: The Health of Lesbian, Gay, Bisexual and Transgender People (Institute of Medicine, 2011), Healthy People 2020

14. www.Out2Enroll.org  Two-thirds of new HIV infections occur among men who have sex with men (MSM) and MSM who are also injection drug users (IDUs).  More than half of people living with HIV/AIDS in the U.S. are MSM.  Gay and bisexual men and transgender women are overwhelmingly affected by HIV and AIDS. Source: CDC, HIV surveillance in men who have sex with men (MSM), data through 2011

15. www.Out2Enroll.org Source: Pew Research Center, June 2013

16. www.Out2Enroll.org Source: Center for American Progress

17. www.Out2Enroll.org A.Yes B.No

18. www.Out2Enroll.org Source: Gallup

19. www.Out2Enroll.org Source: Center for American Progress

20. www.Out2Enroll.org  Same-sex couples often have difficulty accessing coverage for themselves and their children.  Reasons include: Lack of legal relationship recognition Lack of benefits such as employer-sponsored insurance for domestic partners or same-sex spouses Other employment discrimination Lack of second-parent adoption rights

21. www.Out2Enroll.org  Transgender people are frequently denied insurance coverage and health care just because of who they are.  Transgender exclusions remain in many plans.  Types of care affected by exclusions: Preventive screenings (Pap tests, mammograms) Mental health counseling Hormone therapy Gender confirmation surgeries Any other kind of care a trans person might need

22. www.Out2Enroll.org

25.  AIDS service organizations  LGBT community centers  Community health centers  LGBT Pride festival organizations  Affirming churches and other congregations  LGBT state equality organizations  LGBT social groups and venues

26. www.Out2Enroll.org  LGBT Nondiscrimination  Financial Assistance  Access to Family Coverage  Better Quality Coverage

27. www.Out2Enroll.org “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.”

28. www.Out2Enroll.org  If a same-sex couple is legally married in any state and file federal taxes jointly, they can apply jointly for the tax credits, regardless of where they live.  Couples who do not file jointly, including those in a domestic partnership or civil union, need to apply for tax credits individually.  A child’s eligibility for financial assistance is tied to the parent that claims the child on their federal taxes.

29. www.Out2Enroll.org  Insurers that offer family or spousal coverage to different-sex spouses must also cover legally married same-sex spouses, regardless of what state they live in.  State Medicaid programs define “marriage” for themselves, even with regard to legally same-sex married couples.

30. www.Out2Enroll.org  Important new protections for LGBT people with HIV, cancer, or other health conditions: Plans can no longer deny coverage because of pre- existing conditions. Plans cannot set annual or lifetime limits on coverage.  Essential health benefits help address LGBT disparities: Preventive screenings Mental health and substance use treatment Prescription drug coverage Reproductive health care

31. www.Out2Enroll.org

32. Include a general nondiscrimination statement during the opening conversation. Display nondiscrimination policies. Post “safe space” or rainbow stickers and posters. Have LGBT reading materials available in waiting areas. Provide unisex bathrooms.

33. www.Out2Enroll.org Don’t assume anything about an individual, such as Gender and gender identity Appropriate name and gender pronoun Sexual orientation Relationship status Family configuration HIV/AIDS status When in doubt, politely ask rather than guessing. “How would you like me to refer to you?” “What pronoun is appropriate?” “How would you like to be addressed?”

34. www.Out2Enroll.org In addition to he/him and she/her, some transgender people may use pronouns such as they/them. Write down and consistently use appropriate name and pronoun, especially if it’s different from the person’s legal record. Use gender-neutral language for families, such as “partner,” “spouse,” and “parent. “Some of that language stuff is really important, you know? I’d either shut down or I’d get angry. I’d be like, you called me ma’am; are you kidding me?” – Transgender man

35. www.Out2Enroll.org State that you ask all questions of every applicant. Give applicants the option to point or write down answers themselves. Never disclose a person’s LGBT status to anyone who does not need the information to provide services. Simply apologize and move on in case of a mistake.

36. www.Out2Enroll.org  Name and gender – on the form (though not in conversation) rely on what’s on the majority of the applicant’s ID documents  Relationship status – legal relationship recognition?  Household configuration – filing joint federal income taxes?  Plan exclusions – transgender exclusions?  Plan formularies – HIV and other medications?  Provider networks – providers listed on www.glma.org or known as a Ryan White Provider?www.glma.org

37. www.Out2Enroll.org

38.  Out2Enroll: www.Out2Enroll.orgwww.Out2Enroll.org  Key Lessons for LGBT Outreach and Enrollment Under the Affordable Care Act (Out2Enroll, 2014): http://out2enroll.org/wp- content/uploads/2014/07/O2E_KeyLessons_FINAL.pdf http://out2enroll.org/wp- content/uploads/2014/07/O2E_KeyLessons_FINAL.pdf  Moving the Needle: The Impact of the Affordable Care Act on LGBT Communities (Center for American Progress, 2014): https://www.americanprogress.org/issues/lgbt/report/2014/11/ 17/101575/moving-the-needle/ https://www.americanprogress.org/issues/lgbt/report/2014/11/ 17/101575/moving-the-needle/  Where to Start, What to Ask: A Guide for LGBT People Choosing Healthcare Plans (Strong Families Coalition, 2014): http://strongfamiliesmovement.org/lgbt-health-care- guidehttp://strongfamiliesmovement.org/lgbt-health-care- guide

39. www.Out2Enroll.org Twitter: @Out2Enroll Facebook: Out2Enroll Tumblr: Out2Enroll

40. www.Out2Enroll.org Kellan Baker kellan@out2enroll.org Katie Keith katie@out2enroll.org Kendall Bills kendall@out2enroll.org

41.  Webinars are available on our website for on- demand viewing.  You will find slides from today’s presentation posted to the front page of our website: www.nationalhivcenter.org. www.nationalhivcenter.org  Please complete the evaluation at the end of the webinar. Your feedback will inform our programming.  If you are interested in individualized technical assistance, please visit our website and complete a TA Request Form.  Join us for our next webinar! Asking the Tough Questions: Self-Assessment to Determine Growth Versus Responsible Closure Tuesday, February 10 at 1:00 PM ET (Find a link to register at our website: www.nationalhivcenter.org )www.nationalhivcenter.org Conclusion Slide