Alert! Health Care for Transgender People is Under Attack

The Transgender Healthcare Access Alert means that access to medically necessary healthcare for transgender people is under severe threat nationwide. This care is often referred to as gender-affirming care and may include medical, mental health, and supportive services for transgender, non-binary, and gender-expansive people. These threats are especially acute for adolescents and pediatric patients, whose access to care has been directly targeted by many state bans, federal actions, investigations, funding threats, and other pressures on healthcare providers.

The alert is included to help LGBTQ+ patients, parents, families, and communities understand that healthcare for transgender people may be limited, changing, or difficult to access. While the alert appears for healthcare facilities listed in the HEI, it does not necessarily indicate whether a specific facility currently provides transgender-specific healthcare services. Because access can change quickly, patients and families should contact facilities directly to confirm what services are available.

No. The alert does not necessarily indicate whether a specific facility currently provides transgender-specific healthcare services. Some facilities with the alert may continue to provide this care. Others may have paused, scaled back, or stopped certain services because of state bans, federal actions, investigations, subpoenas, funding threats, or institutional risk assessments. Others may never have provided these services.

The alert appears for every healthcare facility listed in the directory to signal that access to medically necessary healthcare for transgender people is under severe threat nationwide. Because availability can change quickly, patients and families should contact facilities directly to confirm what services are currently available.

The HEI evaluates a broad set of LGBTQ+ inclusive policies and practices. Across the HEI criteria, facilities are asked about approximately 70 recommended best practices related to nondiscrimination policies, equal visitation, staff training, patient services and support, employee benefits, patient and community engagement, and responsible citizenship. Of the best-practice questions, only two are specific to the direct provision of transgender-specific medical care, often referred to as gender-affirming medical care.

The HEI criteria are intentionally structured as a flexible framework rather than a one-size-fits-all checklist. Many different types of healthcare facilities participate in the HEI, including hospitals, community clinics, student health centers, HIV specialty clinics, reproductive health providers, and other care settings. Not every best practice is appropriate, feasible, or relevant for every facility type, patient population, community need, or institutional capacity.

For that reason, transgender-specific medical care is included as an important best practice, but it is not required for a facility to earn a high HEI score or designation. Facilities can demonstrate LGBTQ+ patient-centered care in many ways, including through nondiscrimination protections, staff training, health equity planning, medical decision-making protections, patient identification and data collection, name and pronoun fields in the EHR, confidentiality training, patient navigation, LGBTQ+ health education resources, and employee benefits.

A high HEI score or designation means that a facility has met specific HEI standards across multiple areas of LGBTQ+ inclusion. It does not guarantee that the facility currently provides every type of healthcare service for transgender people. Because access can change quickly, patients and families should contact facilities directly to confirm what services are currently available.

For the HEI 2026 cycle, the HRC Foundation recognized that healthcare facilities are operating under extraordinary legal, regulatory, and financial threats related to healthcare for transgender people, often referred to as gender-affirming care. In some states, laws or policies now ban or restrict this care. In other states, this care remains legal, but facilities have faced federal pressure, investigations, subpoenas, enforcement actions, and funding threats.

Where state law or other binding legal restrictions prevent a facility from providing certain care, the HRC Foundation did not apply a Responsible Citizenship penalty simply because those services are unavailable. However, in cases where a facility is in a state where care remains legal or protected, but the facility has stopped providing transgender-specific medical care completely in response to external threats, the HRC Foundation has suspended the facility’s HEI score and designation.

Suspension is different from a Responsible Citizenship penalty. It means that although the facility may have technically met the HEI criteria and earned a score or designation through the survey process, the HRC Foundation is not publishing that score or designation while the suspension remains in place. Facilities with suspended status have also been informed that they may not publish, promote, or otherwise represent themselves as holding an HEI 2026 score or designation during the suspension.

The HRC Foundation has used suspension in a small number of prior cases in which litigation was pending or an unresolved review was underway regarding an action taken by a healthcare facility. In the HEI 2026 context, suspension reflects both the seriousness of facilities stopping legally available healthcare for transgender people and the extraordinary external threats affecting healthcare institutions.

This approach is also distinct from situations where a facility has standing institutional policies or directives that limit medically necessary care for transgender patients. Regardless of score or designation status, the HRC Foundation continues to expect all healthcare facilities to treat transgender and non-binary patients with dignity, transparency, and respect, and to support patients to the fullest extent possible.

Even where legal, regulatory, or operational constraints affect the availability of specific services, healthcare facilities can and should continue to support transgender and non-binary patients. This includes maintaining clear nondiscrimination protections, using patients’ names and pronouns, protecting privacy and confidentiality, providing accurate information about available services, supporting continuity of care where possible, and offering appropriate referrals where available.

These practices remain essential to respectful, patient-centered care. Transgender and non-binary patients should be treated with dignity and respect in every healthcare setting, regardless of whether a facility currently provides transgender-specific medical care.

Because access may change quickly, patients and families should contact the facility directly to confirm what services are currently available. Useful questions may include:

- Does the facility currently provide transgender-specific medical care?

- Are services available for adults, youth, or both?

- Are new patients being accepted?

- Are any services limited because of state or federal restrictions?

- If the facility does not provide the care I need, can it provide referrals or help with continuity of care?

- How will my name, pronouns, gender identity, and privacy be respected?

Our colleagues at the Movement Advancement Project maintain an interactive map tracking state laws that restrict or ban medically necessary healthcare for transgender youth. The map also includes information about legal challenges to these laws and identifies states with “shield laws” that protect access to care and the providers who offer it. View the map here.

Because laws, court rulings, and state policies can change quickly, patients, families, and providers should check the map regularly and confirm current requirements with qualified legal or healthcare professionals when making care decisions.

As access to healthcare for transgender people has come under attack, many families have been forced to search for new providers, travel farther for care, or navigate rapidly changing restrictions. The resources below may help patients, parents, and caregivers identify support, understand available options, and connect with patient navigation services. Because access can change quickly, families should confirm current services directly with providers.

Trans Youth Emergency Project: This program, run by the Campaign for Southern Equality, provides one-on-one patient navigation and support for families of transgender youth whose access to healthcare has been affected by restrictions on gender-affirming care. The program may help families identify providers in states where care remains available and may offer logistical or financial support for travel.

LGBTQ+ Healthcare Directory: This free, searchable database lists doctors, medical professionals, and healthcare providers who are knowledgeable and sensitive to the unique health needs of LGBTQ+ people in the USA and Canada.

FAQs for Parents Seeking Gender-Affirming Care for Their Children: Written by people who understand what you're going through and know what it's like to fight for your child's health and happiness - inside this guide, you'll find concrete steps, trusted resources, and hopeful reminders that you're not alone.

FOLX Health and Plume Clinic are nationwide telehealth providers for the LGBTQIA+ community. They provide transition-related care for those 18 and older.  

Looking for local care options? Reach out to your local LGBTQ+ center or LGBTQ+ Equality state organization for more information.