 ASOs/CBOs have been at the fore of advocating for the
health of LGBTQ persons
 ASOs/CBOs are culturally competent in terms of LGBTQ
issues and well-respected within LGBTQ communities
 Well-positioned to assist in enrolling LGBTQ communities
into health care coverage
• In our ASO/CBO Needs Assessment, 80% of respondents said
that at least 10% of their clients were gay or bisexual men and
20% of respondents said 10% of their clients were trans women
• 45% of Ryan White clients in 2013 were gay and bisexual men
Kellan Baker, MPH, MA
Steering Committee Member, Out2Enroll
Senior Fellow, Center for American Progress
Kellan E. Baker, MPH, MA
Steering Committee Member, Out2Enroll
Senior Fellow, Center for American Progress
www.Out2Enroll.org
Our mission: To connect LGBT people and their families
with new affordable coverage options under the ACA.
“Be out. Be healthy. Get covered.”
Federal
Agencies
Project
www.Out2Enroll.org
 Define terms, identities, and concepts associated
with LGBTQ communities.
 Describe systematic health care access barriers
that LGBTQ populations have historically faced,
and how ACA is helping address them.
 Identify best practices and practical tips for
addressing LGBTQ-specific enrollment questions.
 Develop skills for enrolling LGBTQ individuals and
families effectively.
www.Out2Enroll.org
 LGBT: Lesbian, Gay, Bisexual, Transgender
 Queer: A prideful, reclaimed word some LGBT
people use to describe their identity as lesbian,
gay, bisexual, and/or transgender.
 Sexual orientation: Not just about sexuality or who
you are attracted to—also about who you love
and who you create a family with.
• Gay or lesbian
• Heterosexual or straight
• Bisexual
www.Out2Enroll.org
 Gender identity: Each person’s
deeply felt, internal knowledge of
their own gender.
 Transgender: A person whose gender
identity is different from that typically
associated with their assigned sex at birth.
 Trans man: A person who was assigned
the female sex at birth but identifies and
lives as a man.
 Trans woman: A person who was assigned
the male sex at birth but identifies and
lives as a woman.
www.Out2Enroll.org
A.
B.
C.
D.
Straight
Transgender
Heterosexual
Lesbian
www.Out2Enroll.org
A.
B.
C.
D.
700,000
1.3 million
9 million
35 million
www.Out2Enroll.org
Source: www.lgbtmap.org/equality-maps/lgbt_populations
www.Out2Enroll.org
www.Out2Enroll.org
www.Out2Enroll.org
↑ Tobacco and other substance use
↑ Mental health concerns, such as depression
and suicide attempts
↑ Certain cancers, such as breast cancer
↑ HIV/AIDS
↑ Experiences of bullying and violence
Source: The Health of Lesbian, Gay, Bisexual and Transgender People (Institute of Medicine, 2011), Healthy People 2020
www.Out2Enroll.org
 Two-thirds of new HIV infections occur among
men who have sex with men (MSM) and MSM
who are also injection drug users (IDUs).
 More than half of people living with HIV/AIDS
in the U.S. are MSM.
 Gay and bisexual men and transgender women
are overwhelmingly affected by HIV and AIDS.
Source: CDC, HIV surveillance in men who have sex with men (MSM), data through 2011
www.Out2Enroll.org
Treated unfairly by employer
21%
Received poor service because of
being LGB/T
23%
Made to feel unwelcome at a place of
worship
29%
Threatened or physically attacked
30%
Rejected by family or friends
Subjected to slurs or jokes
39%
58%
Source: Pew Research Center, June 2013
www.Out2Enroll.org
70%
60%
50%
40%
30%
20%
10%
0%
<$16,000
$16,000-$23,000
$23,000-$34,000
$34,000-$45,000
Annual Income (among LGBT people with incomes <400% FPL)
Source: Center for American Progress
www.Out2Enroll.org
A. Yes
B. No
www.Out2Enroll.org
30%
25%
20%
24.20%
22.00%
17.20%
16.70%
15%
23.70%
15.00%
17.60%
LGBT
13.20%
Non-LGBT
10%
5%
0%
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Source: Gallup
www.Out2Enroll.org
Source: Center for American Progress
www.Out2Enroll.org
 Same-sex couples often have difficulty accessing
coverage for themselves and their children.
 Reasons include:
• Lack of legal relationship recognition
• Lack of benefits such as employer-sponsored insurance
for domestic partners or same-sex spouses
• Other employment discrimination
• Lack of second-parent adoption rights
www.Out2Enroll.org
 Transgender people are frequently denied
insurance coverage and health care just because
of who they are.
 Transgender exclusions remain in many plans.
 Types of care affected by exclusions:
•
•
•
•
•
Preventive screenings (Pap tests, mammograms)
Mental health counseling
Hormone therapy
Gender confirmation surgeries
Any other kind of care a trans person might need
www.Out2Enroll.org
www.Out2Enroll.org
www.Out2Enroll.org
www.Out2Enroll.org







AIDS service organizations
LGBT community centers
Community health centers
LGBT Pride festival organizations
Affirming churches and other congregations
LGBT state equality organizations
LGBT social groups and venues
www.Out2Enroll.org
 LGBT Nondiscrimination
 Financial Assistance
 Access to Family Coverage
 Better Quality Coverage
www.Out2Enroll.org
“I understand that under federal law,
discrimination is not permitted on the basis of
race, color, national origin, sex, age, sexual
orientation, gender identity, or disability.”
www.Out2Enroll.org
 If a same-sex couple is legally married in any state and
file federal taxes jointly, they can apply jointly for the
tax credits, regardless of where they live.
 Couples who do not file jointly, including those in a
domestic partnership or civil union, need to apply for
tax credits individually.
 A child’s eligibility for financial assistance is tied to the
parent that claims the child on their federal taxes.
www.Out2Enroll.org
 Insurers that offer family or spousal coverage to differentsex spouses must also cover legally married same-sex
spouses, regardless of what state they live in.
 State Medicaid programs define “marriage” for
themselves, even with regard to legally same-sex married
couples.
www.Out2Enroll.org
 Important new protections for LGBT people with
HIV, cancer, or other health conditions:
 Plans can no longer deny coverage because of pre-existing
conditions.
 Plans cannot set annual or lifetime limits on coverage.
 Essential health benefits help address LGBT
disparities:




Preventive screenings
Mental health and substance use treatment
Prescription drug coverage
Reproductive health care
www.Out2Enroll.org
www.Out2Enroll.org
 Include a general
nondiscrimination statement
during the opening conversation.
 Display nondiscrimination
policies.
 Post “safe space” or rainbow
stickers and posters.
 Have LGBT reading materials
available in waiting areas.
 Provide unisex bathrooms.
www.Out2Enroll.org
 Don’t assume anything about an individual, such as
•
•
•
•
•
•
Gender and gender identity
Appropriate name and gender pronoun
Sexual orientation
Relationship status
Family configuration
HIV/AIDS status
 When in doubt, politely ask rather than guessing.
 “How would you like me to refer to you?” “What pronoun is
appropriate?” “How would you like to be addressed?”
www.Out2Enroll.org
 In addition to he/him and she/her, some transgender
people may use pronouns such as they/them.
 Write down and consistently use appropriate name and
pronoun, especially if it’s different from the person’s
legal record.
 Use gender-neutral language for families, such as
“partner,” “spouse,” and “parent.
“Some of that language stuff is really important, you know? I’d either shut
down or I’d get angry. I’d be like, you called me ma’am; are you kidding me?”
– Transgender man
www.Out2Enroll.org
 State that you ask all questions of every
applicant.
 Give applicants the option to point or
write down answers themselves.
 Never disclose a person’s LGBT status to
anyone who does not need the
information to provide services.
 Simply apologize and move on in case of a
mistake.
www.Out2Enroll.org
 Name and gender – on the form (though not in conversation)
rely on what’s on the majority of the applicant’s ID documents
 Relationship status – legal relationship recognition?
 Household configuration – filing joint federal income taxes?
 Plan exclusions – transgender exclusions?
 Plan formularies – HIV and other medications?
 Provider networks – providers listed on www.glma.org or
known as a Ryan White Provider?
www.Out2Enroll.org
www.Out2Enroll.org
 Out2Enroll: www.Out2Enroll.org
 Key Lessons for LGBT Outreach and Enrollment Under the Affordable
Care Act (Out2Enroll, 2014): http://out2enroll.org/wpcontent/uploads/2014/07/O2E_KeyLessons_FINAL.pdf
 Moving the Needle: The Impact of the Affordable Care Act on LGBT
Communities (Center for American Progress, 2014):
https://www.americanprogress.org/issues/lgbt/report/2014/11/17/
101575/moving-the-needle/
 Where to Start, What to Ask: A Guide for LGBT People Choosing
Healthcare Plans (Strong Families Coalition, 2014):
http://strongfamiliesmovement.org/lgbt-health-care-guide
www.Out2Enroll.org
Twitter: @Out2Enroll
Facebook: Out2Enroll
Tumblr: Out2Enroll
www.Out2Enroll.org
Kellan Baker
kellan@out2enroll.org
Katie Keith
katie@out2enroll.org
Kendall Bills
kendall@out2enroll.org
 Webinars are available on our website for on-demand
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 You will find slides from today’s presentation posted to
the front page of our website: www.nationalhivcenter.org.
 Please complete the evaluation at the end of the webinar.
Your feedback will inform our programming.
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please visit our website and complete a TA Request Form.
 Join us for our next webinar!
Asking the Tough Questions:
Self-Assessment to Determine Growth Versus Responsible
Closure
Tuesday, February 10 at 1:00 PM ET
(Find a link to register at our website: www.nationalhivcenter.org )