National Center for Lesbian Rights

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Cases & Advocacy

D.H. v. Snyder

D.H. and John Doe are transgender teenagers who require male chest reconstruction surgery to treat their gender dysphoria. Arizona is refusing to cover this medically necessary treatment because of a categorical exclusion on covering surgical treatments for gender dysphoria in the state’s Medicaid regulations.

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Cases & Advocacy

Prescott v. Rady Children’s Hospital-San Diego

On September 26, 2016, the mother of a transgender teenaged boy who was admitted into Rady Children’s Hospital-San Diego (RCHSD) for inpatient care filed a lawsuit against the hospital for discrimination against her son, Kyler. One day into his 72-hour stay, and after several failed attempts by his mother to correct the discrimination by the hospital, the hospital’s psychiatrist determined that despite his serious mental health issues, Kyler should be discharged early. About five weeks later, Kyler died by suicide.

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Legislation & Policy

Health Care Rights Law

Section 1557 is the key nondiscrimination provision of the Affordable Care Act (ACA). It prohibits discrimination in health programs and activities receiving federal financial assistance, health programs and activities administered by the executive branch, as well as entities created under the ACA, including the Marketplaces and health plans sold through the Marketplaces. Section 1557 protects against discrimination on the basis of race, color, national origin (including language access), sex, age, and disability, and does so by building on existing civil rights laws. It is the first federal law to ban sex discrimination in health care.

Under the Obama administration, the U.S. Department of Health and Human Services (HHS) underwent an extensive, 6-year process to develop regulations for enforcing Section 1557. The Final Rule that it issued in 2016 provides that discrimination on the basis of sex includes discrimination on the basis of pregnancy, false pregnancy, termination of pregnancy, or recovery therefrom, childbirth or related medical conditions, sex stereotyping and gender identity. This was a major victory for LGBTQ people.

Unfortunately, the Trump administration is trying to roll back this victory by replacing the 2016 rule with a new one that would take away the explicit protections for our community. NCLR submitted comments opposing this harmful policy change.

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Legislation & Policy

Denial-of-Care Rule

In January of 2018, the U.S. Department of Health & Human Services (HHS) issued a proposed federal regulation that would allow widespread discrimination in health care delivery in the name of religious liberty. The rule would allow health care providers to refuse to treat someone if their refusal is based on a religious reason. NCLR submitted extensive comments opposing the rule, which was nevertheless issued in final form in May of 2019. A number of organizations and state and local governments sued HHS to prevent the rule from going into effect. NCLR filed amicus briefs in the litigation challenging the rule. The rule was struck down in court. The Trump Administration has appealed the orders vacating the rule.

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Cases & Advocacy

Ketcham v. Regence Bluecross Blueshield of Oregon

Christina Ketcham is a 60-year-old transgender woman who started her transition over four years ago and continues to experience significant distress from the incongruence between her typically masculine facial features and her identity as a woman. To alleviate that distress, Christina’s treating healthcare providers determined that certain facial feminization procedures are medically necessary to treat her gender dysphoria. But, the health insurance offered by her employer has a categorical exclusion for all facial feminization procedures.

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Cases & Advocacy

June Medical Services v. Russo Amicus

On December 2, 2019, NCLR filed an amicus brief in the United States Supreme Court. The case involves a challenge to a law in Louisiana that would force all but one abortion clinic in that state to close, a law that is virtually identical to one in Texas that the Supreme Court struck down as unconstitutional just three years ago in the landmark case <em>Whole Woman’s Health v. Hellerstedt</em>.

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Cases & Advocacy

New York v. U.S. Department of Health and Human Services and Other Lawsuits Challenging the “Denial of Care” Rule Amicus

In 2019, NCLR filed four amicus briefs in eight federal lawsuits challenging a regulation from the U.S. Department of Health and Human Services called “Protecting Statutory Conscience Rights in Health Care.” The Trump Administration’s regulation, more aptly referred to as the “denial of care” rule, would allow health care professionals to deny certain medical treatments or services to patients based on the provider’s own religious or moral beliefs.

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Cases & Advocacy

Title X Gag Rule Cases Amicus

In 2019, NCLR and other LGBTQ organizations filed briefs in multiple challenges to the Trump administration’s domestic “gag rule.” The cases concern a set of regulations from the Department of Health and Human Services that require clinics that provide the full range of reproductive health care – family planning and abortion – to create complete physical and financial separation between abortion and family planning services.

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Cases & Advocacy

Koran v. OPM

Amelie Koran is a federal employee who was denied coverage for transition-related care under the Federal Employees Health Benefits Program (FEHB). The federal Office of Personnel Management is the agency responsible for administering the FEHB, which provides health insurance coverage for millions of current and former federal employees across the country.

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Cases & Advocacy

Pidgeon v. Turner Amicus

In 2013, Houston mayor Annise Parker directed that same-sex spouses of city employees who were legally married in another state be afforded the same benefits as different-sex spouses of city employees. Two individuals, represented by the anti-LGBTQ group Texas Values, filed a lawsuit in Texas state court challenging the extension of benefits to same-sex spouses, arguing that it violated Texas’s prohibition on marriage for same-sex couples.

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Legislation & Policy

California Senate Bill 703

On October 7, 2015, California Governor Jerry Brown signed a landmark bill that protects transgender people who work for companies doing business with state agencies.

Senate Bill 703, authored by California State Senator Mark Leno, prohibits state agencies from entering into a contract in the amount of $100,000 or more with a contractor who discriminates in the provision of benefits based on an employee’s gender identity.

SB 703, which went into effect on January 1, 2016, expands existing enforcement provisions in California contracting law by adding requirements that the Department of General Services provide a web based database listing all contracts subject to this provision, and establish a method for receiving, investigating, and resolving complaints of non-compliance.

SB 703 levels the playing field in state contracting between in-state and out-of-state companies while also ensuring that state tax dollars are used in a cost-effective manner and do not go to companies that discriminate.

The bill was co-sponsored by NCLR, Equality California, and the Transgender Law Center.

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Cases & Advocacy

B.H., a transgender boy

When B.H. was in second grade, his peers began bullying and ostracizing him because he’s transgender. Worse, some parents organized a campaign to force the school district to stop treating B.H. as male, and to prohibit him from using the boys’ restroom. It didn’t take long before B.H. began showing significant psychological distress and his mom asked NCLR for help. NCLR worked with the school district to safeguard B.H.’s right to learn in a safe and welcoming environment.

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Cases & Advocacy

Stormans v. Selecky Amicus

In 2007, The Washington State Board of Pharmacy began requiring that pharmacists provide patients with prescribed medications if those medications are in stock. Additionally, pursuant to a long-standing rule governing which medications a pharmacy should have on its shelves, pharmacies would have to begin stocking Plan B, a prescription contraceptive. A pharmacy and two pharmacists sued the Washington State Board of Pharmacy alleging that its rules violated their religious liberty.

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Legislation & Policy

Patient Protection and Affordable Care Act

The 2010 Patient Protection and Affordable Care Act (ACA) has been a critical piece of legislation for expanding access to health care, including for the LGBTQ community. One of its critical features is a statutory prohibition on discrimination in health care based on sex. NCLR advocated extensively with the U.S. Department of Health and Human Services (HHS), the federal agency that enforces these protections, to ensure that sexual orientation and gender identity are included within the scope of the ACA nondiscrimination rule. In 2016, HHS issued a rule specifying that it would indeed interpret the nondiscrimination provision as covering LGBTQ people.

Unfortunately HHS under the Trump administration has taken a different view, and is in the process of seeking to change the regulations to take away some of the explicit protections for sexual orientation and gender identity. NCLR filed extensive comments in the record opposing these changes and is continuing to monitor developments in this area.

It is important to note that while HHS can make changes to its regulations, it cannot change the underlying statute, which still contains the prohibition against sex discrimination. Some courts have interpreted the statute to include sexual orientation and gender identity regardless of what HHS does. If you experience discrimination in health care due to your sexual orientation or gender identity you still have the ability to take legal action.

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Legislation & Policy

Medicare for All

On February 27, 2019, Representative Pramila Jayapal (WA) introduced the Medicare for All Act of 2019 (H.R.1384/S.1804) to establish a national health insurance program to combat the high costs of healthcare and health-related services for all U.S. residents. The Medicare for All Act would provide guaranteed access to affordable healthcare for all persons living in the U.S. Establishing an universal healthcare system is a top priority for LGBTQ people, because they are less likely to have health insurance than non-LGBTQ people.

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Cases & Advocacy

Annie F. and Lyndy R.

Annie and Lyndy had been together for nearly thirteen years when Annie suffered a debilitating stroke. About ten years later, Annie entered hospice care while Lyndy continued to care for her. Despite legal documents designating Lyndy as the person responsible to make medical decisions for her, a state entity removed Annie from her shared home with Lyndy and petitioned for a public guardian.

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Legislation & Policy

Equal Access to Fertility

California fertility service providers are permitted to offer people seeking to conceive using a known sperm donor access to certain fertility services on the same terms as different-sex couples under Assembly Bill 2356 (2012), which went into effect January 1, 2013. This bill was authored by Assemblymember Nancy Skinner and co-sponsored by Equality California and the National Center for Lesbian Rights.

Increasingly, women in same-sex couples, transgender people, and single women are asking trusted friends to act as sperm donors in order to conceive a child. California was the first state to legally recognize that people may use known donors (not just anonymous sperm donors) to conceive a child.

However, people using known donors could not access the same fertility services as women in different-sex relationships. Different-sex couples can have insemination services using fresh sperm. Known donors’ sperm must typically be frozen and quarantined for six months. Insemination using fresh sperm is more effective and less costly.

AB 2356 allows providers to provide insemination services using fresh (unfrozen) sperm to people using known donors. Providers are not required to offer this service, but this law clarifies that they may offer it.

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Legislation & Policy

Federal Hospital Visitation Rule

The National Center for Lesbian Rights was a lead partner with the Department of Health and Human Services (HHS) on the development of the administration’s historic Hospital Visitation Rule. The Rule came at the direction of President Obama who urged HHS to identify ways to protect the hospital visitation rights of all patients through policy change. NCLR worked closely with HHS on the final rule, which guarantees equal treatment in hospital visitation to all patients and their loved ones regardless of sexual orientation, gender identity, biological relationship, or marital status. Subsequent to the introduction of that Rule in 2011, we have worked closely with HHS on implementation. We co-hosted a webinar with HHS, which provided education on the impact of the Rule and “Best Practices‚” for working with the LGBTQ community. We continue to work with HHS to clarify that this Rule also applies to nursing homes and hospice facilities.

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Cases & Advocacy

Adams v. Federal Bureau of Prisons

Vanessa Adams is a transgender woman who was diagnosed by Federal Bureau of Prison (BOP) medical professionals with Gender Identity Disorder (GID) in 2005 while she was incarcerated in a BOP prison. Over the next few years, she made at least 19 written requests asking for medical treatment for GID. The BOP denied all of her requests outright based on its so-called “freeze frame” policy in which treatment for any person with GID is kept frozen at the level provided at the time he or she entered BOP custody. In Ms. Adams’ case, this meant that because she had not received treatment for GID before being incarcerated, BOP would not provide her with medically necessary care even though its own doctors diagnosed her with GID, told her about treatments available for GID, and knew about the seriousness of her medical condition. As a result of these denials of treatment, Ms. Adams attempted suicide multiple times and engaged in other avenues of self- treatment in an attempt to live more consistently with her gender identity.

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Cases & Advocacy

Greene v. County of Sonoma

Greene and Scull lived together for 20 years and had executed both mutual powers of attorney for medical and financial decisions and wills naming each other as beneficiaries. In April 2008, County employees separated the couple after Scull fell outside their shared home. In the next three months, County officials ignored the couple’s legal documentation, unlawfully auctioned their possessions, terminated their lease, and forced Greene into an assisted living facility against his will.

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Cases & Advocacy

Mariah L. v. Administration for Children’s Services Amicus

Mariah L. sought coverage for transition-related healthcare as a 20-year-old transgender woman in foster care in New York City. Mariah’s doctors have all agreed that sex reassignment surgery is medically necessary for her. In New York, the Administration for Children’s Services (ACS) has a duty to provide and pay for all necessary medical care and treatment for children placed in foster care, but ACS has refused to provide Mariah with the medical care that she needs.

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Cases & Advocacy

Benitez v. North Coast Women’s Care Medical Group Amicus

Guadalupe “Lupita” Benitez was denied infertility treatment by her Southern California healthcare providers because she is a lesbian. The trial court rejected the doctors’ claim that they do not have to follow California’s anti-discrimination law because they have religious objections to serving lesbian patients.

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Supreme Court Rules on Title VII! Give now & Celebrate!