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Fact Sheet

If you are denied insurance coverage for transition-related health care, consider taking these steps:

  1. Get a copy of your health insurance policy to see if there is any discriminatory exclusion language. If so, find out what the process is to appeal a denial of coverage. You will likely need to provide written documentation from your doctor that this treatment is deemed medically necessary for you.

  2. Use official statements from any of the following five organizations as backup for your argument that transition-related health care is not cosmetic or elective and should be covered:

    American Medical Association

    According to the AMA: “An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with GID … Therefore, Be it Resolved, that the AMA supports public and private health insurance coverage for treatment of gender identity disorder.”

    American Psychological Association

    The “APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments.”

    American Academy of Family Physicians

    In 2007, an AAFP Commission declared that the association has a policy opposing any form of patient discrimination and stated its opposition to the exclusion of transgender health care:“RESOLVED, That the American Academy of Family Physicians endorse payment by third party payors to provide transsexual care benefits for transgender patients.”

    National Association of Social Workers

    “NASW supports the rights of all individuals to receive health insurance and other health coverage without discrimination on the basis of gender identity, and specifically without exclusion of services related to transgender or transsexual transition…in order to receive medical and mental health services through their primary care physician and the appropriate referrals to medical specialists, which may include hormone replacement therapy, surgical interventions, prosthetic devices, and other medical procedures.”

    World Professional Association for Transgender Health

    WPATH found that decades of experience with the Standards of Care show gender transitions and related care to be accepted, good medical practice and effective treatment. In a 2008 clarification, WPATH stated:

    "Sex reassignment, properly indicated and performed as provided by the Standards of Care, has proven to be beneficial and effective in the treatment of individuals with transsexualism, gender identity disorder, and/or gender dysphoria. Sex reassignment plays an undisputed role in contributing toward favorable outcomes, and comprises Real Life Experience, legal name and sex change on identity documents, as well as medically necessary hormone treatment, counseling, psychotherapy, and other medical procedures...

    "The medical procedures attendant to sex reassignment are not ‘cosmetic’ or ‘elective’ or for the mere convenience of the patient. These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of the diagnosed condition."

  3. Contact Lambda Legal’s Help Desk (toll-free: 866-542-8336 or www.lambdalegal.org/help)

Lambda Legal and the Center for HIV Law and Policy provide an overview of the HIV criminalization legal landscape, 2008-2010.

As Lambda Legal celebrates its 35th anniversary, we take a moment to look back and reflect on our humble yet ambitious beginnings. We are pleased to present a special edition of In My Own Words, shared with us by one of our founders, Bill Thom.

Lambda Legal began with its name on a Band-Aid on my apartment mailbox and a $25 bank account. When I founded the organization in 1973, the idea of legal defense and education funds was in the air. The National Organization for Women had created one, and there was the Native American Legal Defense and Education fund and the Puerto Rican Legal Defense and Education Fund. It was part of the ethos at the time.

Bill Thom.
Bill Thom
“Those of us who were there in the beginning were involved because we believed in the cause — equality for LGBT communities.“

I had been offering legal assistance to an organization called the Gay Activists Alliance. Their political work involved courting politicians to support gay and lesbian causes. They also held more radical actions, like sit-ins. While I was there it occurred to me that something like Lambda Legal would be a good idea for lesbians and gay men, so I began doing the paperwork. I followed the Puerto Rican Legal Defense Fund’s paperwork word for word, except I changed the beneficiaries from Puerto Ricans to lesbians and gay men. A New York court turned down the application for incorporation on the grounds that I had not demonstrated the organization was “benevolent or charitable.” So I became involved in a court battle that would reach the highest court in the state of New York before we even got permission to incorporate.

From the beginning, we had two roles to play: the first litigation, the second education. We were ambitious and wanted to have a national focus. Initially, our board was composed of six men. My partner became the general counsel and, as I recall, I was president and chief cook and bottle washer for the first five years. I think in our best year we probably raised $50,000. That was worth a good deal more then than it is now, but it still wasn’t a great deal of money. I took a couple fundraising courses, but we were inexperienced. It felt at times like we were just muddling through. We were fairly cautious about the cases we took. Even though we were doing the legal work for nothing, lawsuits have a lot of other expenses. For instance, in the military challenge that my partner handled against the Department of Defense, the case was tried in Washington, D.C. Anytime there was activity in that case, he had to make that trip. If it’s a busy case, as this one was, the costs can add up.

The defense department settled that case, and we later took cases involving access in federal prisons to gay publications, a couple custody cases, and an immigration case. We had quite a crosssection from the beginning, and since we had no publicity budget it was surprising how quickly we became known. We met once a month as a board and we would discuss the facts of a case, the resources it would take and the opportunity for the case to be precedent-setting. The key to being a successful legal advocacy organization is to get the best factual case you can. So it was very important in those early days for us to determine whether we had as close to an optimum set of facts as we could to make the best case.

Those of us who were there in the beginning were involved because we believed in the cause — equality for LGBT communities — but one of the things that has allowed Lambda Legal to endure and prosper is that it we always put the clients first and the cause second. It was always about the people. We still have a long way to go in the fight for equal rights across the board for our communities. But the changes I’ve seen since I got involved 35 years ago are so astonishing and so widespread that I’m pretty confident that we’re going to have substantial equality in my lifetime — and I’m no spring chicken.

Youth in foster care and juvenile justice systems who are lesbian, gay, bisexual, transgender or questioning (LGBTQ) or living with HIV have basic rights.

Are you and your same-sex partner thinking about traveling or moving to another state but worried about whether your relationship will be respected? Or have you joined the growing movement to advocate that employers or organizations, when choosing sites for a convention or meeting, avoid locales that require or promote discrimination against same-sex relationships?

We've prepared this information so you can start your assessment. The next step would be to review other facts about a state, such as whether it has an anti-LGBT statute.

New York has enacted legislation providing same-sex couples with equal access to marriage. This document explains how marriage equality may affect same-sex couples and families with low or no income, and provides general information about your legal rights. Please note that this document is not intended to provide legal advice or guidance regarding any specific situation.

In recent years, the federal Internal Revenue Service (IRS) has refused to grant tax-exempt 501(c)(3) status to LGBT community centers with a more than insubstantial amount of activities that appear to be social or recreational in nature. LGBT community centers may therefore wish to exercise caution in the amount of such activities that they undertake. In addition, they may wish to avoid emphasizing such activities in the organization’s mission statement, in written materials, and on its website, as the IRS may consider these in evaluating tax-exempt status. Where activities that may appear to be social or recreational are in fact undertaken for charitable purposes, LGBT community centers may wish to make those purposes clear.

Read the text of the legislation: H.R. 1116 and S. 598.

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