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Transgender Rights | Healthcare | Connecticut

Can healthcare plans discriminate against LGBTQ+ people?

In general, under federal and Connecticut state law, nearly all health plans cannot discriminate on the basis of sex, and, because the Supreme Court ruling in Bostock v. Clayton Co. concluded that all gender identity and sexual orientation discrimination is a form of sex discrimination, nearly all health plans cannot discriminate against LGBTQ+ people.

What health care plan protections are provided by Connecticut?

Connecticut Insurance Department Bulletin

In 2013, the Connecticut Insurance Department issued a bulletin directing all health insurers that are regulated by the Department to pay for treatment related to a patient’s gender transition. 

Connecticut Medicaid (HUSKY Health)

The State of Connecticut Department of Social Services (DSS) was one of the first Medicaid programs in the United States to add comprehensive coverage of treatment and services for gender transition to its Medicaid program.   

In 2015, Connecticut Medicaid amended its regulations to eliminate all references to gender reassignment as an “experimental” or “unproven treatment.”  In 2017, coverage was added to HUSKY B, Connecticut’s Children’s Health Insurance Program.  The addition of this coverage was in recognition of the clear clinical evidence that such services were not experimental and should be covered as part of the Medical Assistance programs.  

Over the past several years, DSS has developed coverage guidelines for gender reassignment surgery and related gender transition services that are based on the best clinical knowledge available. All decisions are based on the medical necessity of a particular service and a person-centered assessment of the treatment needs of the specific Medicaid member

Connecticut Commission on Human Rights and Opportunities (CHRO) Ruling

In 2020, the Connecticut Commission on Human Rights and Opportunities issued a landmark ruling prohibiting all employers and insurers from denying coverage for transgender people’s healthcare needs relating to gender transition. 

The ruling states:

Insurance policies that categorically refuse to consider certain procedures for certain people on the basis of their race, sex, or sexual orientation are facially discriminatory. So too are such exclusions for transgender people on the basis of gender identity, a condition unique to them. Consequently, when the State or a municipality contracts for health insurance plans that contain categorical exclusions for treatments related to gender dysphoria – and especially when the same treatments are covered for treatment of other conditions – it commits a discriminatory practice, as does the insurer. 

Are there any health care plans that are not protected under Connecticut law?

Yes. Medicare and employer health plans that are self-funded (also known as self-insured) are governed by federal law.

Ki pwoteksyon plan swen sante gouvènman federal la bay?

Medicare

In 2013, Medicare removed the ban on coverage for the treatment of gender dysphoria because it was “experimental” and began to cover medically necessary treatment for gender dysphoria.

Seksyon 1557 nan Lwa sou Swen Sante Abòdab (ACA)

Section 1557 makes it unlawful for any health care provider that receives funding from the Federal government to refuse to treat an individual – or to otherwise discriminate against the individual – based on sex (as well as race, color, national origin, age, or disability). Section 1557 imposes similar requirements on health insurance issuers that receive federal financial assistance. Healthcare providers and insurers are barred, among other things, from excluding or adversely treating an individual on any of these prohibited bases. The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces, and health programs administered by HHS.

Anjeneral, Seksyon 1557 la pa aplike pou plan sante gwoup ki finanse tèt yo anba ERISA oswa plan kout tèm ki gen yon dire limite paske antite ki ofri plan yo tipikman pa prensipalman angaje nan biznis bay swen sante, ni yo pa resevwa asistans finansyè federal.

In May 2021, the Biden Administration announced that the Health and Human Services Office for Civil Rights (OCR) would interpret and enforce Section 1557 of the ACA and Title IX’s nondiscrimination requirements based on sex to include sexual orientation and gender identity. The update was made in light of the June 2020 U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.

In enforcing Section 1557, OCR will comply with the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb et seq., and all other legal requirements and applicable court orders that have been issued in litigation involving the Section 1557 regulations.

Tit VII

For employers with 15 or more employees, Title VII bans discrimination on the basis of race, color, religion, sex, and national origin in hiring, firing, compensation, and other terms, conditions or privileges of employment. Employment terms and conditions include employer-sponsored healthcare benefits. Historically, not all authorities have agreed that Title VII protects LGBTQ+ workers against discrimination.

However, the Supreme Court decision in Bostock v. Clayton Co. changes this because that ruling made it clear that sexual orientation and gender identity discrimination are forms of sex discrimination. Although the decision is about wrongful employment termination, it has implications for employer-sponsored health plans and other benefits. For example, employers may want to adjust group health plan coverage of gender dysphoria and related services, including gender-affirmation surgeries, and review and compare benefits for same-sex and opposite-sex spouses.

Èske patwon relijye yo ka diskrimine moun LGBTQ+?

Nan dat 8 Jiyè 2020, nan Lekòl Notre-Dame de Guadalupe kont Morrissey-Berru, the United States Supreme Court reaffirmed its stance on the application of ministerial exception to employment discrimination cases as established in earlier rulings. In doing so, the Court simultaneously raised an unanswered issue under Title VII: does the ministerial exception for religious employers allow those organizations to discriminate against employees or candidates based on their LGBTQ+ status?

It’s unclear at this point how the Court’s ruling in Lekòl Notre-Dame de Guadalupe kont Morrissey-Berru may impact the LGBTQ+ employees of religious employers, but religious organizations and employers should recognize that the ministerial exception does not apply to every position within their organizations. Rather, it is limited to those employees who truly perform religious duties. For example, the position of a school janitor who is only present in the building outside of school hours and is not responsible for transmitting the faith would likely not be considered ministerial in nature

Ki etap mwen ka pran pou m jwenn asirans pou tretman disfori sèks?

  1. First, check to see if your health plan provides coverage for the type of treatment that you want by getting a copy of the plan’s “Summary of Benefits and Coverage.”
  2. Pifò plan asirans, ni piblik ni prive, gen egzijans detaye ki dwe satisfè pou jwenn pwoteksyon. Sa a patikilyèman vre si w ap eseye jwenn pwoteksyon pou yon operasyon ki gen rapò ak tranzisyon. Kidonk, kontakte plan sante w la epi mande yon kopi egzijans pou tretman w ap chèche a. 
  3. Travay avèk terapis ak doktè ou yo pou asire w ke ou satisfè tout egzijans plan sante a. Dokimantasyon ki soti nan terapis ak doktè ou yo se faktè ki pi enpòtan pou detèmine si demann tretman ou an ap apwouve. 
  4. Tcheke ki tretman ki bezwen apwobasyon alavans. Nan pifò ka yo, nenpòt operasyon ap bezwen apwobasyon alavans, epi plan an ka peye sèlman si ou itilize yon chirijyen ki aksepte plan yo a. 
  5. If your treatment request is denied, find out the reasons for the denial, and, if you still think that you qualify for the treatment, follow the plan’s appeal process. Usually, there will first be an internal appeals process, and, if you are not successful there, you can sometimes appeal to an outside agency. Make sure that you adhere to the deadlines— failure to meet a deadline can automatically end your ability to appeal. 
  6. Keep GLAD informed if you are denied treatment. GLAD may be able to offer suggestions that can help you win your appeal. You can contact GLAD Answers by filling out the form at Repons GLAD oubyen pa telefòn nan 800-455-GLAD (4523). 
  7. Although more health plans now cover treatment for gender dysphoria, the process for obtaining treatment, particularly for transition-related surgery, can be time-consuming and frustrating. A great deal of documentation is required and finding a surgeon that does the type of surgery, and who is also acceptable to the health plan, can be difficult. 
  8. Pa pè pèsiste epi depoze dosye a ankò si yo refize ba ou. 

Kijan pou m jwenn yon chirijyen ki pral pran asirans sante mwen an?

De pli zan pli chirijyen ki fè operasyon pou chanje sèks pran asirans sante. Ou ta dwe fè rechèch sou chirijyen yo ak anpil atansyon pou jwenn youn ki bon pou ou. Ou ka gade lis founisè ki nan rezo a ke plan ou an bay pou wè si yo enkli oswa si li gen ladan nenpòt chirijyen nan zòn ou an, epi si non, ou ka kontakte biwo chirijyen an pou detèmine si yo aksepte asirans ou an. Pifò plan asirans sante egzije pou ou itilize yon founisè medikal nan rezo ou a, men si rezo ou a pa gen ladan yon chirijyen ki fè sèvis ou bezwen yo, ou ka kapab soti nan rezo a si ou mande otorizasyon alavans nan men plan ou an.

Kisa m ta dwe fè si y ap fè diskriminasyon kont mwen nan swen sante?

If you are being discriminated against by a healthcare facility or provider or if you have a health plan that is regulated by the Connecticut Insurance Department, you can file a discrimination complaint with the Connecticut Commission on Human Rights and Opportunities. See the “Discrimination” Issue Area for detailed information about how to do this.

Si ou gen yon plan swen sante ki gouvène pa Seksyon 1557 nan ACA a, ou ka depoze yon plent nan Biwo Dwa Sivil Depatman Sante ak Sèvis Sosyal federal la. Pou plis enfòmasyon, gade: How to File a Civil Rights Complaint. 

Si ou gen yon plan swen sante ki finanse tèt ou atravè yon anplwayè ki gen omwen 15 anplwaye, ou ka depoze yon plent pou diskriminasyon bay Komisyon Egalite Opòtinite nan Anplwa (EEOC) federal la. Pou plis enfòmasyon, gade Zòn Pwoblèm "Diskriminasyon" an.

Resous

Connecticut Department of Insurance Bulletin on “Gender Identity Nondiscrimination Requirements”: Bulletin IC-37 Gender Identity Nondiscrimination Requirements. 

HUSKY Health policies and procedures for providers: HUSKY Health Program | Providers | Gender Affirmation Surgery Policy. 

CHRO ruling: 1 STATE OF CONNECTICUT COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES DECLARATORY RULING ON PETITION REGARDING HEALTH INSURERS’. 

Connecticut Health Care Guidance: Health Insurance Regulations – Connecticut. 

The New England Transgender Healthcare Consortium consists of providers from over one dozen healthcare facilities in New England who are dedicated to improving access to gender-affirming care. For more information, see:  New England Gender CARE. 

Polis Asirans Sante ak Polis Medikal: Health insurance Medical Policies. 

Transgender Legal Defense & Education Fund memo to plan administrators on liability for transgender health care exclusions:  February 21, 2022 Re: Liability for transgender health care exclusions in employer health plans 

Enfòmasyon sou plan Out2Enroll ACA pou 2022: Plan Information for 2022 – Out2Enroll. 

Swen sante pou moun transjèn: Transgender health care coverage | HealthCare.gov. 

HHS pral aplike Seksyon 1557 pou pwoteje moun LGBTQ+ yo: HHS Will Enforce Section 1557 To Protect LGBTQ People From Discrimination | Health Affairs. 

Sant Nasyonal pou Egalite Transjan (NCTE): Konnen dwa ou nan swen sante: Know Your Rights: Healthcare.

Gid Swen Sante NCTE:  Health Coverage Guide | National Center for Transgender Equality. 

Pwoteksyon EEOC anba Tit VII pou moun LGBTQ+ anba diskriminasyon: Protections Against Employment Discrimination Based on Sexual Orientation or Gender Identity | US Equal Employment Opportunity Commission.

Gid pou Chirijyen ki espesyalize nan kesyon sèks: TransHealthCare.

Transgender Rights | ID Documents | Connecticut

GLAD offers an initiative called the Transgender ID Project that provides free resources for transgender people living in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, or Vermont) seeking to update their legal name and gender on federal and state identification documents.

Nan plizyè ka, ou ka mete dokiman sa yo ajou san asistans yon avoka lè w sèvi ak enfòmasyon ki anba yo. Si w bezwen èd, gade kesyon ki anba a: Ki kote m ka jwenn èd pou chanje non m ak sèks mwen sou plizyè dokiman idantite?

How do I obtain a legal name change in Connecticut?

To obtain a legal name change, you apply to either your local Probate or Superior Court. Here are the instructions for applying to Probate Court: Procedure for Applying to the Probate Court for Change of Name.

Adults need to complete and submit the following forms:

To change the name of a minor, you must complete and submit the following forms: 

Applicants who are indigent or otherwise unable to pay the application fee of $250 may be eligible for a waiver by completing and submitting Form PC-184: Request/Order Waiver of Fees (Petitioner). 

Do I need to publish my name change in a newspaper?

No. Connecticut does not have this requirement.

How do I change the name and gender on my Connecticut driver’s license?

Here are the instructions for changing name and gender on a Connecticut driver’s license or identification card: GENDER DESIGNATION ON A LICENSE OR IDENTIFICATION CARD

If you are changing your name, you must first change it on your Social Security card. You must also submit a name change order from a court (NOTE: It doesn’t need to be from a Connecticut court) and complete the following form: CHANGE OF NAME OR NAME CORRECTION REQUEST 

To change the gender on an adult driver’s license or identification card, you must submit Form B-385: GENDER DESIGNATION ON A LICENSE OR IDENTIFICATION CARD. In addition to “Male” and “Female,” there is a gender-neutral “Non-Binary” option.

If the person requesting the change is a minor, a parent or guardian must be present and sign the B-385 form, or the minor must submit a signed and notarized 2D form with the B-385: Here is a link to the 2D Form: CERTIFICATE OF PARENTAL CONSENT DEPARTMENT OF MOTOR VEHICLES NOTARIZATION (Not valid unless notarized below) SUBSCRIBED AND SWORN.

NOTE: Beginning May 3, 2023, if you want to use a state ID to fly domestically or enter a federal building, it will need to be a REAL ID. For more information about obtaining a CT REAL ID, see: Connecticut Real ID – CT DMV Information 

If I was born in Connecticut, how do I change the name and gender on my birth certificate?

In 2015, Connecticut changed the law to allow a person to amend the sex designator on his or her birth certificate to reflect such person’s gender transition, without requiring any surgical treatment. Instead, the sex designator on the birth certificate can be amended if the registrant provides an affidavit from a physician, advance practice registered nurse, or psychologist, that the registrant has undergone surgical, hormonal or other treatment clinically appropriate for the purpose of gender transition.

The steps and forms for changing name and gender on a Connecticut birth certificate can be found here: Listed below are the necessary documents that the Department of Public Health will need to amend the sex designator on your birth certificate.

In addition to “Male” and “Female,” Connecticut allows a “Non-Binary” gender neutral option.

Ki kote m ka jwenn èd pou chanje non m ak sèks mwen sou plizyè dokiman idantite?

La Pwojè Dokiman Idantifikasyon Transjèn se yon pwojè konjwen GLAD, Massachusetts Transgender Political Coalition (MTPC), ak kabinè avoka Ropes & Gray LLP ak Goodwin. Li mete yon rezidan nan nenpòt nan sis eta New England yo an kontak ak yon avoka pro bono (gratis) nan youn nan kabinè avoka sa yo. Sepandan, akòz popilarite pwogram nan, li ka pran plizyè semèn anvan yon avoka nan youn nan kabinè sa yo kontakte w. Pou plis enfòmasyon epi pou aplike pou Pwojè a, ale nan: Transgender ID Project – GLAD.

However, in most cases, by using the information and forms provided here, you can update these documents fairly easily on your own without the assistance of an attorney.

Resous

The National Center for Transgender Equality (NCTE) has an ID Documents Center with information about changing name and gender on state and federal ID documents. You can find information about Connecticut here: Connecticut | National Center for Transgender Equality

Ka ak Defans

To see Transgender Rights cases or advocacy which GLAD has been directly involved with in Connecticut, go to: Ka ak Defans – GLAD and under “By Issue” click on “Transgender Rights” and under “By Location” click on “Connecticut.”

Nouvèl ak Kominike pou laprès

To see news and press releases about Transgender Rights in Connecticut, go to: Nouvèl ak Kominike pou laprès – GLAD and under “By Issue” click on “Transgender Rights” and under “By Location” click on “Connecticut.”