LGBTQ+ Patient Rights: How to Get Affirming Care and File Discrimination Complaints

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Updated: August 3, 2026

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LGBT adults are twice as likely as non-LGBT adults to report unfair or disrespectful treatment from a provider. Half delayed needed care last year because of cost. Federal protections have narrowed since 2024. State law now determines most coverage and complaint outcomes.

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IF YOU’RE EXPERIENCING HEALTH CARE DISCRIMINATION RIGHT NOW

Call Lambda Legal’s Help Desk at 1-866-542-8336 for free legal guidance.

Right now: Write down names, dates and exact statements. Request your full medical record from the provider in writing.

This week: File a Section 1557 complaint with the HHS Office for Civil Rights. You have 180 days. Appeal any coverage denial in writing. If the insurer denies the appeal, escalate to your state insurance commissioner.

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LGBTQ+ HEALTH CARE AT A GLANCE
  • More than half of LGBT adults (51%) skipped or postponed needed care in the past year because of cost, compared with 34% of non-LGBT adults.
  • Forty-three percent of LGBT adults struggle to pay for health care. Thirty-nine percent had trouble affording prescription drugs.
  • One in three LGBT adults (33%) say a provider treated them unfairly or with disrespect in the past three years, roughly twice the rate non-LGBT adults reported (15%).
  • For 25% of LGBT adults, health got worse after skipping or postponing care due to cost, compared with 18% of non-LGBT adults.
  • Medicaid is the primary coverage source for 13% of LGBT adults, compared with 7% of non-LGBT adults. Eligibility rules vary by state.
  • Health care costs are a worry for 76% of LGBT adults. Your deductible and out-of-pocket maximum affect what you pay. See our health insurance buying guide to compare plans.

*KFF and Williams Institute define their study populations as “LGBT adults.” MoneyGeek uses “LGBTQ+” only in editorial framing, not when citing a specific statistic.

An illustrative image of someone finding a health care provider.

How to Recognize Health Care Discrimination

KFF's 2023 Racism, Discrimination and Health Survey documented four provider behaviors that LGBT adults report at roughly twice the rate of non-LGBT adults.

Unfair or Disrespectful Treatment

Thirty-three percent of LGBT adults say a provider treated them unfairly or with disrespect in the past three years, compared with 15% of non-LGBT adults. Most reports involve clinicians who dismiss concerns or refuse to use a patient's correct name and pronouns.

First action: Document the incident the same day. Then ask the facility's patient advocate for a written response. The Joint Commission’s accreditation lookup has patient relations contacts for most accredited hospitals.

Assumptions Without Asking

Forty percent of LGBT adults report a provider assumed something about them without asking, compared with 17% of non-LGBT adults. Providers may presume a patient's gender identity or family structure based on appearance alone.

Next step: Correct the record in writing through the patient portal. A written update means future providers see accurate information from the start.

Being Blamed for a Health Problem

Thirty-two percent of LGBT adults say a provider suggested they were personally to blame for a health problem, compared with 15% of non-LGBT adults. It comes up most in mental health and sexual health visits.

First action: Request a second opinion in writing. Ask the new clinician to add their notes to your record.

Having Questions or Requests Ignored

Thirty-two percent of LGBT adults report a provider ignored a direct request or question, compared with 14% of non-LGBT adults. About 60% of LGBT adults prepare for a negative experience before each visit. Some bring a support person; others rehearse how to describe their symptoms.

First action: Submit your question through the patient portal. The provider's response, or lack of one, then becomes part of the record.

Cost and Coverage Barriers

Cost is the largest single barrier to care for LGBT adults, separate from the four provider behaviors above. KFF found that 51% skipped needed care in the past year because of cost. For 25%, health got worse as a result. Coverage denials and exclusions for gender-affirming care add pressure. For the 13% of LGBT adults on Medicaid, those barriers are hardest to work around. If you're shopping the ACA marketplace, compare plans on network and care exclusions, not just premium.

First action: Request any coverage denial or plan exclusion in writing. File an internal appeal before your insurer's deadline. For the federal process, see HealthCare.gov’s appeals page.

What to Do if You’re Discriminated Against

  1. 1
    Document Everything

    Write down what happened the same day. Note the date, time, location and the name and title of everyone involved. Use quotation marks for direct statements. Save voicemails, portal messages, denial letters and Explanation of Benefits documents. Providers must respond to a written medical records request under HIPAA within 30 days.

  2. 2
    Use the Facility’s Internal Process First

    Most hospitals and large practices have a patient advocate or grievance line. Ask for the facility's nondiscrimination policy in writing. Then file your complaint with patient relations or compliance. Request a written response with a timeline.

  3. 3
    File a Federal Section 1557 Complaint

    Most hospitals and any provider that accepts Medicaid, Medicare or ACA marketplace plans receive federal funding. If yours does, file with the HHS Office for Civil Rights under Section 1557 of the Affordable Care Act. File online within 180 days. You don't need a lawyer.

    Federal protections for sexual orientation and gender identity have been narrowed by 2025 rulemaking and ongoing litigation. Outcomes aren't guaranteed, but the complaint record matters even when enforcement is uncertain. File anyway.

  4. 4
    File State-Level Complaints

    State protections can exceed federal law, especially in states with explicit sexual orientation and gender identity nondiscrimination statutes.

    • State medical board: for complaints about provider conduct or refusal of care. The Federation of State Medical Boards directory lists every board.
    • State insurance commissioner: for coverage denials and network adequacy disputes. The NAIC commissioner directory lists your state's office.
    • State attorney general or human rights commission: for civil rights violations.
    • State Medicaid office: for Medicaid denials involving gender-affirming care.
  5. 5
    Get Free Legal Help
  6. 6
    Appeal a Coverage Denial

    Use the formal appeals process for denials covering gender-affirming care, PrEP, fertility care or mental health treatment. For letter templates, see our guide to appealing health insurance denials.

    1. Request the denial in writing with the plan language cited.
    2. File an internal appeal before the insurer's deadline. For most plans, that's 180 days.
    3. Cite Section 1557 and any applicable state nondiscrimination law.
    4. If denied again, request an external review through your state insurance department.
    5. For Medicaid denials, request a fair hearing. Deadlines vary by state. Most set a 90-day window.
  7. 7
    Protect Your Mental Health Through the Process

    Don't put care on hold while you wait on a complaint. For immediate support, call 988 and press 3 for LGBTQ+ counselors. Trans Lifeline is available at 1-877-565-8860; the Trevor Project serves callers under 25 at 1-866-488-7386. Before leaving a discriminating provider, use the directories below to find an affirming alternative.

What Are the LGBTQ+ Patient Protections Under Federal and State Law in 2026?

Federal protections have narrowed over the past two years. State law now drives most access to nondiscriminatory and gender-affirming care.

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    Federal: Contested, Not Settled

    Section 1557 of the Affordable Care Act still prohibits sex-based discrimination in federally funded health programs, but protections for sexual orientation and gender identity have been narrowed by 2025 rulemaking and ongoing litigation. A November 2025 JAMA Health Forum analysis documented federal policy changes for LGBTQ+ populations: Medicaid eligibility changes, restrictions on gender-affirming care and revised nondiscrimination rules.

    The July 4, 2025 reconciliation bill is expected to leave millions of low-income and moderate-income people uninsured. Medicaid access will tighten further under the bill's provisions. Because LGBT adults have lower incomes and higher Medicaid reliance than non-LGBT adults, the changes affect this community more. If you're losing coverage, HealthCare.gov has plan options. Use our individual health insurance guide to compare them.

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    State: Where Most Protection Is Now

    Federal law no longer settles whether insurers can deny coverage based on sexual orientation or gender identity, what Medicaid covers for gender-affirming care, or how far religious refusals can reach. State law fills those gaps. For live updates, the Movement Advancement Project’s interactive map is the most current source.

State-by-State LGBTQ+ Health Care Protections (2026)

The table summarizes Movement Advancement Project tallies as of May 2026. State laws change frequently. Verify with MAP before making major decisions.

Table last verified: May 26, 2026. By: Nathan Paulus.

Alabama
No
No
Yes
No
Alaska
No
No
No
No
Arizona
No
No
Partial
No
Arkansas
No
No
Yes
No
California
Yes
Yes
No
Yes
Colorado
Yes
Yes
No
Yes
Connecticut
Yes
Yes
No
Yes
Delaware
Yes
Yes
No
Yes

Washington, D.C.

Yes
Yes
No
Yes
Florida
No
No
Yes
No
Georgia
No
No
Yes
No
Hawaii
Yes
Yes
No
Yes
Idaho
No
No
Yes
No
Illinois
Yes
Yes
No
Yes
Indiana
No
No
Yes
No
Iowa
No
No
Yes
No
Kansas
No
No
Yes
No
Kentucky
No
No
Yes
No
Louisiana
No
No
Yes
No
Maine
Yes
Yes
No
Yes
Maryland
Yes
Yes
No
Yes
Massachusetts
Yes
Yes
No
Yes
Michigan
Yes
Yes
No
Yes
Minnesota
Yes
Yes
No
Yes
Mississippi
No
No
Yes
No
Missouri
No
No
Yes
No
Montana
No
No
Yes
No
Nebraska
No
No
Partial
No
Nevada
Yes
Yes
No
Yes
New Hampshire
Yes
No
No
Yes
New Jersey
Yes
Yes
No
Yes
New Mexico
Yes
Yes
No
Yes
New York
Yes
Yes
No
Yes
North Carolina
No
No
Yes
No
North Dakota
No
No
Yes
No
Ohio
No
No
Yes
No
Oklahoma
No
No
Yes
No
Oregon
Yes
Yes
No
Yes
Pennsylvania
Partial
Yes
No
No
Rhode Island
Yes
Yes
No
Yes
South Carolina
No
No
Yes
No
South Dakota
No
No
Yes
No
Tennessee
No
No
Yes
No
Texas
No
No
Yes
No
Utah
No
No
Yes
No
Vermont
Yes
Yes
No
Yes
Virginia
Yes
Yes
No
Yes
Washington
Yes
Yes
No
Yes
West Virginia
No
No
Yes
No
Wisconsin
No
No
No
No
Wyoming
No
No
No
No
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HOW TO READ THIS TABLE

A "Yes" in any column means that law is in effect in that state.

  • Column 1: Under state law, insurers can't deny coverage on the basis of sexual orientation or gender identity.
  • Column 2: State Medicaid covers gender-affirming care when a provider determines it is medically necessary.
  • Column 3: The state restricts gender-affirming care for minors. Some states apply those limits to adults on public coverage as well.
  • Column 4: The state prohibits licensed mental health providers from practicing conversion therapy on minors.
An illustrative image of a patient getting treatments.

How to Find an Affirming Provider

National directories screen providers for LGBTQ+ competency. Start with the list below, then narrow by state and specialty.

National directories:

Coverage and legal help:

Urgent mental health support:

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About Christopher Murray

Christopher Murray, Personal Finance Writer

Christopher Murray is a personal finance and sustainability writer who contributes finance articles to MoneyGeek. His work spans budgeting, socially responsible investing (SRI) and cryptocurrency, with a focus on sustainability as a practical savings strategy.

Christopher earned his degree in English literature and gender studies from Smith College.

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