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Healthcare Laws and Policies

Insurance nondiscrimination laws and policies protect LGBTQ people from being unfairly denied health insurance coverage or from being unfairly excluded from coverage for certain health care procedures on the basis of sexual orientation or gender identity. "Bans on transgender exclusions in health insurance" are policies that bar health insurers from explicitly refusing to cover transgender-related health care benefits.
United States Map
Washington New York U.S. Virgin Islands Puerto Rico Guam Commonwealth of the Northern Mariana Islands American Samoa New Hampshire Vermont Virginia Pennsylvania New York Maine West Virginia Ohio Kentucky Indiana Michigan Illinois Wisconsin North Carolina South Carolina Tennessee Georgia Florida Mississippi Missouri Arkansas Louisiana Iowa Minnesota Oklahoma Kansas Nebraska South Dakota North Dakota Texas 33 Colorado Wyoming Montana Idaho Arizona Utah Nevada Oregon California Hawaii Alaska Massachusetts Rhode Island Connecticut New Jersey Delaware Maryland Washington D.C. New Hampshire Vermont
  • Transgender exclusions in health insurance service coverage prohibited (24 states + D.C.)
  • Law prohibits health insurance discrimination based on sexual orientation and gender identity (15 states , 1 territory + D.C.)
  • Law prohibits health insurance discrimination based only on gender identity only (8 states)
  • Law prohibits health insurance discrimination based only on sexual orientation only (0 states)
  • No law providing LGBTQ inclusive insurance protections (25 states, 4 territories)
  • Law explicitly permits insurers to refuse to cover gender-affirming care (2 states)

Citations & More Information
*In Mississippi, state law explicitly allows private insurers to refuse to cover gender-affirming care for minors, as part of its statewide ban on best practice medical care for transgender youth. Arkansas law allows this refusal of coverage for gender-affirming care for everyone, regardless of age. For more information about this and every state, click "Citations & More Information" beneath the map legend. 


Recommended citation:
Movement Advancement Project. "Equality Maps: Healthcare Laws and Policies." https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies. Accessed 11/21/2024. 

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

40%

40 % of LGBTQ population lives in states with insurance protections that include sexual orientation and gender identity

15%

15 % of LGBTQ population lives in states with insurance protections that include only gender identity

0%

0 % of LGBTQ population lives in states with insurance protections that include only sexual orientation

44%

44 % of LGBTQ population lives in states that do not have LGBT-inclusive insurance protections

55%

55 % of LGBTQ population lives in states that prohibit transgender exclusions in health insurance service coverage

2%

2 % of LGBTQ population lives in states that permit insurers to refuse to cover gender-affirming care

This map reflects state laws or administrative policies which explicitly include, explicitly exclude, or have no clear policy covering transition-related or gender-affirming care for transgender people who are state employees as part of their state employee health benefits.
United States Map
  • State explicitly includes gender-affirming care in its state employee health benefits (24 states + D.C.)
  • State does not mention or has no clear policy regarding gender-affirming care in its state employee health benefits (12 states, 5 territories)
  • State explicitly excludes gender-affirming care from its state employee health benefits (14 states)

Citations & More Information
*Green states with an asterisk cover transgender-related medical care but may require preauthorization or pre-approval for receiving it.
*In both Florida and South Carolina, the states exclude coverage of medical care for transgender people from its state employee plans, but in both states there are also appellate court decisions that ruled such exclusions unconstitutional. There are still ongoing lawsuits however.  Click the "Citations & More Information" button beneath the map legend for more detail about this and every state.
*Oklahoma has multiple plans available to state employees. According to TLDEF's research, two of these plans have explicit exclusions; one has no policy either way; and one has no policy, but the provider (Blue Cross) has its own policy that includes gender-affirming care. However, because this is a Blue Cross policy and not an Oklahoma policy, and the state has multiple other plans with exclusions, Oklahoma is coded here as having exclusionary plans. Please see TLDEF's research for more detail, or click "Citations & More Information" beneath the map legend for more detail about every state.
*In West Virginia, an April 2024 ruling from the 4th Circuit Court of Appeals found unconstitutional the state's previous exclusions of transgender-related care in its state plans, but the decision is being appealed. This map will be updated as the case progresses.

Recommended citation:
Movement Advancement Project. [Year of access]. "Equality Maps: Healthcare Laws and Policies." https://www.mapresearch.org/equality-maps/healthcare_laws_and_policies. Accessed 11/21/2024. 

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

55%

55 % of the LGBTQ population lives in states that explicitly include gender-affirming care in its state employee health benefits

18%

18 % of LGBTQ population lives in states that do not mention or has no clear policy regarding gender-affirming care in its state employee health benefits

27%

27 % of LGBTQ population lives in states explicitly exclude gender-affirming care from its state employee health benefits

Key
  • State has law that only covers sexual orientationLaw covers sexual orientation
  • State has law that covers sexual orientation and gender identityLaw covers sexual orientation and gender identity/expression
  • State has law that covers gender identityLaw covers gender identity
  • Bans insurance exclusions of transgender health care
  • State does not have this law Bans best practice medical care for transgender youth
  • State has this law Policy includes transgender health care
  • State does not have this law Policy excludes transgender health care
State Private Insurance
Nondiscrimination		 Transgender Inclusive Health Benefits for State Employees
  Citations Citations
Alabama
Alaska
American Samoa
Arizona
Arkansas State does not have this law
California
State has law that covers sexual orientation and gender identity 		State has this law
Colorado
State has law that covers sexual orientation and gender identity
Connecticut
State has law that covers gender identity 		State has this law
Delaware
State has law that covers sexual orientation and gender identity 		State has this law
District of Columbia
State has law that covers sexual orientation and gender identity 		State has this law
Florida State does not have this law
Georgia State has this law
Guam
Hawaii
State has law that covers gender identity 		State has this law
Idaho State does not have this law
Illinois
State has law that covers sexual orientation and gender identity 		State has this law
Indiana State has this law
Iowa
Kansas State has this law
Kentucky State has this law
Louisiana State does not have this law
Maine
State has law that covers sexual orientation and gender identity 		State has this law
Maryland
State has law that covers sexual orientation and gender identity 		State has this law
Massachusetts
State has law that covers gender identity 		State has this law
Michigan
State has law that covers sexual orientation and gender identity
Minnesota
State has law that covers sexual orientation and gender identity 		State has this law
Mississippi State does not have this law
Missouri
Montana State has this law
Nebraska State does not have this law
Nevada
State has law that covers sexual orientation and gender identity 		State has this law
New Hampshire
State has law that covers sexual orientation and gender identity 		State has this law
New Jersey
State has law that covers gender identity 		State has this law
New Mexico
State has law that covers gender identity
New York
State has law that covers sexual orientation and gender identity 		State has this law
North Carolina State has this law
North Dakota State does not have this law
Northern Mariana Islands
Ohio State does not have this law
Oklahoma State does not have this law
Oregon
State has law that covers sexual orientation and gender identity 		State has this law
Pennsylvania
State has law that covers gender identity 		State has this law
Puerto Rico
State has law that covers sexual orientation and gender identity
Rhode Island
State has law that covers gender identity 		State has this law
South Carolina State does not have this law
South Dakota State does not have this law
Tennessee State does not have this law
Texas State does not have this law
U.S. Virgin Islands
Utah State does not have this law
Vermont
State has law that covers sexual orientation and gender identity
Virginia
State has law that covers gender identity
Washington
State has law that covers sexual orientation and gender identity 		State has this law
West Virginia
Wisconsin
State has law that covers sexual orientation and gender identity 		State has this law
Wyoming
Data current as of 11/06/2024
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Sexual Orientation Policy Tally

The term “sexual orientation” is loosely defined as a person’s pattern of romantic or sexual attraction to people of the opposite sex or gender, the same sex or gender, or more than one sex or gender. Laws that explicitly mention sexual orientation primarily protect or harm lesbian, gay, and bisexual people. That said, transgender people who are lesbian, gay or bisexual can be affected by laws that explicitly mention sexual orientation.

Gender Identity Policy Tally

“Gender identity” is a person’s deeply-felt inner sense of being male, female, or something else or in-between. “Gender expression” refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms and speech patterns that can be described as masculine, feminine, or something else. Gender identity and expression are independent of sexual orientation, and transgender people may identify as heterosexual, lesbian, gay or bisexual. Laws that explicitly mention “gender identity” or “gender identity and expression” primarily protect or harm transgender people. These laws also can apply to people who are not transgender, but whose sense of gender or manner of dress does not adhere to gender stereotypes.

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