By: Coverys Risk Management

Transgender individuals are receiving a lot of media attention these days with reality series, dramas, and documentaries featuring transgender adults, teens, and children. This media attention is generating dialogue about transgender rights, equality, and access to appropriate healthcare. If your organization has not considered the unique needs and challenges of this patient population, the time to do so is now.

When seeking healthcare, transgender individuals experience a number of barriers, including: limited access to appropriate care, lack of health insurance or coverage limitations, and electronic medical records that are not designed to accommodate different expressions of gender identity.

Access to Care

According to a 2010 Lambda Legal Survey, 51.9 percent of transgender respondents expressed concern that they would be refused healthcare services. In 2011, results from the National Transgender Discrimination Survey indicated that 19 percent of respondents reported they had been denied health services based on their transgender or gender nonconforming status.

In response to reports and statistics such as those above, The Joint Commission began requiring accredited organizations to include gender identity in their nondiscrimination policies and practices.

Nineteen states include sexual orientation and gender identity nondiscrimination protections. Hospital leaders and healthcare providers need to be aware of the extent of protections afforded under state law and comply. Currently the gender identity protections that were included in section 1557 of the Affordable Care Act have been enjoined by a Texas federal court ruling.

In addition to fear of being refused care, transgender individuals face a medical establishment that has little knowledge of their unique needs. Fifty percent of the respondents to the National Transgender Discrimination Survey reported they had to “teach their medical providers about transgender care.”

Lack of Health Insurance Coverage

Many transgender individuals lack access to healthcare for socioeconomic reasons, as many are unemployed or underemployed. Those that do have health insurance may be faced with limited coverage for transgender-specific services, particularly related to gender reassignment surgery. The health insurance payment process is not equipped to handle transgender primary care.

Consider the following example:

The patient was designated male at birth and identifies as female. She has had her driver’s license and birth certificate changed to reflect her identified gender. She is now legally identified as female. During her annual physical, her provider completes a prostate exam and orders a PSA test. The bill is submitted using the patient’s identified gender (as appropriate) and the claim is rejected due to the discordance between the examination/test and the patient’s identified gender.

Gender Identity and Electronic Health Records (EHRs)

In the example presented above, the patient was designated male at birth and identifies as female. How can this be addressed in an EHR system’s binary field of male/female? The answer is that gender is not binary, and EHRs must progress to permit a more accurate reflection of gender identity. The Fenway Institute recommendsthat EHRs include the following gender options:

  • Male
  • Female
  • Female-to-Male (FTM)/Transgender Male/Trans Man
  • Male-to-Female (MTF)/Transgender Female/Trans Woman
  • Genderqueer, neither exclusively male nor female
  • Additional Gender Category/(or Other), Please specify: _______
  • Decline to answer

The Office of the National Coordinator of Health Information Technology is working to make sure that the gender identity options suggested by the Fenway Institute are included in certified healthcare technologies.

Six Things You Can Do to Improve Transgender Care in Your Organization

  1. Provide compassionate care to transgender patients, as you do to all patients. Use pronouns appropriate to the patient’s gender identity and apologize if you make a mistake. Do not discriminate. Ensure that transgender individuals have reasonable access to restrooms. When possible, identify single-stall restrooms as “family” or “unisex” to provide a safe alternative to gender-specific restrooms for your transgender patients and visitors. Room transgender individuals according to their identified gender and address problems and concerns that may arise as you do other patient and visitor conflicts. Do not charge a transgender patient extra for a private room if the placement is at the convenience of the hospital and was not requested by the patient. State laws are constantly changing; stay up to date on what the latest requirements are where you practice.
  2. Ensure patient care policies that address patient rights and visiting policies include gender identity nondiscrimination language. Ensure staff members are aware of the policies and that nondiscrimination is enforced. For more information and sample policy language, see Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies.
  1. Provide role-specific education and training to staff members regarding the care of transgender individuals. Clinical caregivers should have an age-specific understanding of hormone therapies, surgical interventions, and gender dysphoria. For more information, see publications and training materials from the National LGBT Health Education Center.
  2. Work with your health information technology team to develop an appropriate EHR solution to accurately reflect gender in medical records. See also Electronic Medical Records and the Transgender Patient: Recommendations from the World Professional Association for Transgender Health EMR Working Group.
  3. Work with health insurers to develop and implement strategies to prevent immediate rejection of claims based on gender discrepancies. Work with your registration and billing staff members to make sure they appropriately collect gender identity information to facilitate patient care and billing.
  4. Show your commitment by participating in the Human Rights Campaign’s Healthcare Equality Index

All patients have the right to the same standard of care regardless of their gender identity. Every individual has the right to choose their gender identity regardless of biology and to have that choice respected. The spectrum of gender identity is broad. As healthcare providers, we must care for these patients. In the words of Dr. Robert Garofalo, former president of the Gay and Lesbian Medical Association (GLMA), “As long as there are transgender individuals who struggle for access to health care; and as long as there are LGBT youth who even contemplate suicide as a result of their sexual identity, our work remains incomplete.”


No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.