Direitos Transgêneros

Healthcare 

ID Documents (jump to section)

 

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. concluiu que toda discriminação de identidade de gênero e orientação sexual é uma forma de discriminação sexual; quase todos os planos de saúde não podem discriminar pessoas LGBTQ+.

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?

Sim. O Medicare e os planos de saúde do empregador que são autofinanciados (também conhecidos como auto-assegurados) são regidos pela lei federal.

Quais proteções do plano de saúde são fornecidas pelo governo federal?

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.

Seção 1557 da Lei de Assistência Médica Acessível (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.

A Seção 1557 geralmente não se aplica a planos de saúde coletivos autofinanciados sob ERISA ou planos de duração limitada de curto prazo porque as entidades que oferecem os planos normalmente não estão envolvidas principalmente no negócio de fornecer assistência médica, nem recebem assistência financeira federal.

Em maio de 2021, o governo Biden anunciou que o Escritório de Direitos Civis de Saúde e Serviços Humanos (OCR) interpretaria e aplicaria a Seção 1557 da ACA e os requisitos de não discriminação com base no sexo do Título IX, incluindo orientação sexual e identidade de gênero. A atualização foi feita à luz da decisão da Suprema Corte dos EUA de junho de 2020 no caso Bostock v. Clayton County e decisões judiciais subsequentes.

Ao aplicar a Seção 1557, o OCR cumprirá a Lei de Restauração da Liberdade Religiosa, 42 USC § 2000bb e seq.., e todos os outros requisitos legais e ordens judiciais aplicáveis que foram emitidos em litígios envolvendo os regulamentos da Seção 1557.

Título 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.

No entanto, a decisão do Supremo Tribunal 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.

Empregadores religiosos podem discriminar pessoas LGBTQ+?

Em 8 de julho de 2020, em Escola Nossa Senhora de Guadalupe v. Morrissey-Berru, a Suprema Corte dos Estados Unidos reafirmou sua posição sobre a aplicação da exceção ministerial a casos de discriminação no emprego, conforme estabelecido em decisões anteriores. Ao fazê-lo, a Corte levantou simultaneamente uma questão sem resposta sob o Título VII: a exceção ministerial para empregadores religiosos permite que essas organizações discriminem funcionários ou candidatos com base em sua condição LGBTQ+?

It’s unclear at this point how the Court’s ruling in Escola Nossa Senhora de Guadalupe v. 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

Que medidas posso tomar para obter cobertura para tratamento de disforia de gênero?

  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. A maioria dos planos de saúde, tanto públicos quanto privados, possui requisitos detalhados que devem ser atendidos para obter cobertura. Isso é particularmente verdadeiro se você estiver tentando obter cobertura para uma cirurgia relacionada à transição. Portanto, entre em contato com seu plano de saúde e solicite uma cópia dos requisitos para o tratamento que você está buscando. 
  3. Trabalhe com seus terapeutas e médicos para garantir que você atenda a todos os requisitos do plano de saúde. A documentação dos seus terapeutas e médicos é o fator mais crítico para determinar se sua solicitação de tratamento será aprovada. 
  4. Check what treatment requires pre-approval. In most cases, any surgery will require pre-approval, and the plan may only pay if you use a surgeon that takes their plan. 
  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. Mantenha o GLAD informado caso seu tratamento seja negado. O GLAD pode oferecer sugestões que podem ajudá-lo a vencer seu recurso. Você pode entrar em contato com o GLAD Answers preenchendo o formulário em Respostas GLAD ou por telefone em 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. Não tenha medo de ser persistente e de reapresentar o pedido caso ele seja negado. 

Como faço para encontrar um cirurgião que aceite meu plano de saúde?

More and more surgeons who perform sex reassignment surgeries take health insurance. You should research surgeons carefully to find one who is a good fit for you. You can look at the list of in-network providers provided by your plan to see if they are included or if it includes any surgeons in your area, and if not, you can contact the surgeon’s office to determine if they accept your insurance. Most health insurance plans require that you use a medical provider in your network, but if your network does not include a surgeon who performs the services you need, you may be able to go out of network if you seek prior authorization from your plan.

O que devo fazer se estiver sofrendo discriminação na área da saúde?

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.

Se você possui um plano de saúde regido pela Seção 1557 da ACA, pode registrar uma reclamação junto ao Escritório de Direitos Civis do Departamento de Saúde e Serviços Humanos do governo federal. Para mais informações, consulte: Como registrar uma queixa de direitos civis. 

Se você possui um plano de saúde autofinanciado por meio de um empregador com pelo menos 15 funcionários, pode registrar uma queixa de discriminação junto à Comissão Federal para a Igualdade de Oportunidades de Emprego (EEOC). Para mais informações, consulte a Área Temática "Discriminação".

Recursos

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. 

Health Insurance Medical Policies: 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 

Out2Enroll ACA plan information for 2022: Plan Information for 2022 – Out2Enroll. 

Transgender health care: Transgender health care coverage | HealthCare.gov. 

HHS will enforce Section 1557 to protect LGBTQ+ people: HHS Will Enforce Section 1557 To Protect LGBTQ People From Discrimination | Health Affairs. 

National Center for Transgender Equality (NCTE): Know Your Rights in Health Care: Know Your Rights: Healthcare.

NCTE Health Care Guide:  Health Coverage Guide | National Center for Transgender Equality. 

EEOC Title VII discrimination protections for LGBTQ+ people: Protections Against Employment Discrimination Based on Sexual Orientation or Gender Identity | US Equal Employment Opportunity Commission.

Guide to Gender Surgeons: 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.

In many cases, you can update these documents without the assistance of a lawyer using the information below. If you do need help, see the question below: Where can I get help changing my name and gender on various ID documents?

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.

Where can I get help changing my name and gender on various ID documents?

O Transgender ID Document Project is a joint project of GLAD, Massachusetts Transgender Political Coalition (MTPC), and law firms Ropes & Gray LLP and Goodwin. It matches a resident from any of the six New England states with a pro bono (free) attorney at one of these law firms. However, because of the popularity of the program, it may be several weeks before you are contacted by an attorney from one of these firms. For more information and to apply for the Project, go to: 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.

Recursos

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

Casos e Advocacia

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

Notícias e comunicados de imprensa

To see news and press releases about Transgender Rights in Connecticut, go to: Notícias e comunicados de imprensa – GLAD and under “By Issue” click on “Transgender Rights” and under “By Location” click on “Connecticut.”