States With Mandatory Health Insurance – Insurance nondiscrimination laws and regulations protect LGBTQ people from being unfairly denied health insurance or excluded from health insurance coverage for certain health care procedures based on sexual orientation or gender identity. The “transgender health insurance exclusion ban” is the policy that prohibits health insurance companies from expressly refusing to cover transgender-related health care benefits.
*Mississippi state law expressly allows private insurers to deny care to gender-affirming minors as part of the state’s best practices ban on medical care for transgender youth. Arkansas law allows this to deny sex coverage to anyone, regardless of age. For more information on this and each state, click on “Citations and more information” under the map legend.
States With Mandatory Health Insurance
*Note: These percentages reflect the estimated population of LGBTQ adults living in all 50 states and the District of Columbia. Estimates of the population of LGBTQ adults in the five populated areas of the United States are not available and therefore cannot be reflected here.
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41% of LGBTQ people live in states that have coverage that includes sexual orientation and gender identity.
This map reflects state laws or administrative regulations that expressly include, expressly exclude, or have no express policy covering transition-related or gender-affirming care for transgender individuals who are state employees.
*States with a green star cover gender-affirming care, but prior authorization or approval may be required to receive it. * Oklahoma has many programs available to state employees. According to TLDEF research, two of these plans have glaring exclusions: neither has a policy. 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 several other programs with exclusions, Oklahoma is coded here as having exclusion programs. Please see the TLDEF survey for more detailed information or click on “Citations and More Information” under the map legend for more details on each state.
59% of LGBTQ people live in states that explicitly include gender-affirming care in public employee health benefits.
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15% of the LGBTQ population lives in states that do not specify or have clear gender-affirming health care policies for state employees.
26% of the LGBTQ population lives in states that expressly exclude gender-affirming care from state employee health benefits.
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The term “sexual orientation” is clearly defined as a pattern of romantic or sexual attraction to people of the same or opposite sex, of the same sex or gender, or of more than one sex or gender. Laws that clearly state sexual orientation primarily protect or harm queer, gay, and bisexual people. However, transgender individuals who are heterosexual, gay, or bisexual may be subject to laws that clearly state sexual orientation.
“Gender identity” is a deeply felt inner sense that one is male, female, or something else or in between. “Gender expression” refers to a person’s characteristics and behaviors, such as appearance, clothing, behavior, and speech patterns, that may be described as male, female, or otherwise. Gender identity and expression are independent of sexual orientation, and transgender people may identify as heterosexual, queer, gay, or bisexual. Laws that expressly address “gender identity” or “gender identity and expression” generally protect or harm transgender people. These laws may also apply to people who are not transgender, but whose gender identity or dress style does not conform to gender stereotypes. Many people need fertility help to have children. This can either be due to an infertility diagnosis, or because they are in a same-sex relationship or are single and want children. Although there are many different forms of fertility help available, many services are out of reach for many people due to cost. Fertility treatment is expensive and often not covered by insurance. While some private insurance plans cover diagnostic services, there are many insurance coverages for treatment services such as IUI and IVF, which are more expensive. Most people who use fertility services must pay out of pocket, with costs often running into thousands of dollars. Several states require private insurance plans to cover infertility services, and only one state requires coverage under Medicaid, the low-income health insurance program. This widens the gap for low-income people, even when they have health coverage. This brief examines how access to fertility services, both diagnostic and treatment, varies in the United States by state policy, insurance type, income level, and patient demographics.
Infertility is most commonly defined1 as the inability to conceive after one year of regular unprotected heterosexual intercourse, and affects approximately 10-15% of heterosexual couples. Both female and male factors contribute to infertility, including problems with ovulation (when the ovary releases an egg), structural problems with the uterus or fallopian tubes, problems with sperm quality or motility, and hormonal factors (Figure 1). About 25% of infertility is more than one factor, and about 10% of infertility is unexplained. Infertility estimates, however, do not account for LGBTQ or single people who may also need fertility assistance to start a family. Therefore, there are many reasons that may prompt people to seek fertility treatment.
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A wide range of diagnostic and therapeutic services may be needed to assist fertility (Table 1). Diagnosis usually involves laboratory tests, sperm or discharge analysis, and imaging studies or procedures of the reproductive organs. If a probable cause of infertility is found, treatment is often aimed at eliminating the source of the problem. For example, if a person has normal levels of thyroid hormones, thyroid medication can help the patient get pregnant. If the patient has large fibroids that distort the uterine cavity, surgical removal of these benign tumors may allow future pregnancies. Other times, other interventions are needed to help the patient achieve pregnancy. For example, if the sperm analysis reveals poor sperm motility or blocked fallopian tubes, the sperm will not be able to fertilize the egg, and intrauterine insemination (IUI) or in vitro fertilization (IVF) may be considered. These procedures also facilitate family building for LGBTQ and single people using donor eggs or sperm with or without a gestational carrier (surrogacy).
SOURCE: ACOG. Assessment results. 2017 ACOG. Treatment of infertility. 2019 American Society for Reproductive Medicine. Sterility. OVERVIEW Patient information series. 2017
Our analysis of the 2015-2017 National Survey of Family Growth (NSFG) shows that 10% of women aged 18-49 say they or their partners have never talked to a doctor about how to help them get pregnant (data not shown) : The most common service among women aged 18-49 is fertility counseling (Figure 2).
The CDC notes that the use of IVF has steadily increased since the first successful birth in 1981. According to the most recent data, approximately 1.8% of US children become pregnant each year using assisted reproductive technology (ART) (such as IVF and procedures with ratio). , NJ 3.9%), and lower in the South and Southwest (NM 0.4%, AR 0.6%, MS 0.6%).
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The use of fertility services has declined dramatically during the public health emergency of COVID-19. On March 17, 2020, the American Society for Reproductive Medicine (ASRM) issued guidelines to stop all new cycles of fertility treatment and non-urgent diagnostic procedures. Since then, ASRM has provided updated guidance on what conditions must be met and steps taken before fertility treatments can be safely resumed. Meanwhile, Strata Decision Technology’s study of 228 hospitals in 40 states found that patient appointments for fertility services dropped 83% between March 22 and April 4, 2020, compared to this time last year.
Many patients do not have access to fertility services, mainly due to high costs and private insurance and Medicaid coverage. As a result, many people who use fertility services have to pay out of pocket even if they have insurance otherwise. Individual costs vary widely by patient, state of residence, provider, and insurance plan. In general, diagnostic laboratory tests, sperm or discharge analysis, and ultrasound are less invasive than diagnostic procedures (eg, HSG) or surgery (eg, hysteroscopy, laparoscopy). Meanwhile, treatment using fertility drugs is less expensive than IUI and IVF, but even the cheapest treatment can still result in thousands of dollars out of pocket. Many people have to try several treatments before they or their partners can get pregnant (usually medication first, followed by surgery or fertility procedures if medication is unsuccessful). A study
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