We are glad you found us. The Department of Health and Human Services’ Office for Civil Rights (OCR) understands that many people, family members, friends, and health care providers are facing fear and concerns about efforts by some state and local governments to prevent people from accessing health care and human services on the basis of their sexual orientation or gender identity.
Understanding Your Rights
Civil rights are personal rights guaranteed and protected by the U.S. Constitution and federal laws. Civil rights include protection from unlawful discrimination.
OCR is the law enforcement agency within HHS that is responsible for guaranteeing that people are free from discrimination based on race, color, national origin (including primary language), disability, age, religion, and sex (including pregnancy, sexual orientation, and gender identity) by certain health care and human services. OCR also enforces a range of civil rights and health information privacy laws. For more information about these laws, see our Civil Rights page and our HIPAA page.
“The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation. Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences. It is the position of the Department of Health and Human Services that everyone – including LGBTQ people - should be able to access health care, free from discrimination or interference, period.” -- HHS Secretary Xavier Becerra.
Discrimination on the Basis of Sexual Orientation and Gender Identity
OCR is responsible for enforcing Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination against individuals on the basis of race, color, national origin, sex, age, and disability in covered health programs or activities.
Section 1557’s prohibitions of discrimination on the basis of sex to includes: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. The update was made in light of the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.
OCR recognizes that discrimination in health care impacts health outcomes. Research shows that one quarter of LGBTQ people who faced discrimination postponed or avoided receiving needed medical care for fear of further discrimination. OCR’s mission is to protect people from all forms of discrimination. OCR will follow Supreme Court precedent and federal law, and ensure that the law’s protections extend to those individuals who are discriminated against based on sexual orientation and gender identity.
On June 15, 2020, the U.S. Supreme Court held that Title VII of the Civil Rights Act of 1964 (Title VII)’s prohibition on employment discrimination based on sex encompasses discrimination based on sexual orientation and gender identity. Bostock v. Clayton County, GA, 140 S. Ct. 1731 (2020). The Bostock majority concluded that the plain meaning of “because of sex” in Title VII necessarily included discrimination because of sexual orientation and gender identity. Id. at 1753-54. Consistent with the Supreme Court’s decision in Bostock and Title IX, beginning today OCR will interpret Section 1557’s prohibition on discrimination on the basis of sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. This interpretation will guide OCR in processing complaints and conducting investigations, but does not itself determine the outcome in any particular case or set of facts.
In enforcing Section 1557 as stated above, OCR will comply with the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb et seq., and all other legal requirements. Additionally, OCR will comply with all applicable court orders that have been issued in litigation involving the Section 1557 regulations, including Franciscan Alliance, Inc. v. Azar, 414 F. Supp. 3d 928 (N.D. Tex. 2019); Whitman-Walker Clinic, Inc. v. U.S. Dep’t of Health & Hum. Servs., 485 F. Supp. 3d 1 (D.D.C. 2020); Asapansa-Johnson Walker v. Azar, No. 20-CV-2834, 2020 WL 6363970 (E.D.N.Y. Oct. 29, 2020); and Religious Sisters of Mercy v. Azar, No. 3:16-CV-00386, 2021 WL 191009 (D.N.D. Jan. 19, 2021).
OCR applies the enforcement mechanisms provided for and available under Title IX when enforcing Section 1557’s prohibition on sex discrimination. 45 C.F.R. § 92.5(a). Title IX’s enforcement procedures can be found at 45 C.F.R. § 86.71 (adopting the procedures at 45 C.F.R. §§ 80.6 through 80.11 and 45 C.F.R. Part 81).
Gender Affirming Care
HHS stands with transgender and gender nonconforming youth and their families—and the significant majority of expert medical associations—in unequivocally stating that gender affirming care for minors, when medically appropriate and necessary, improves their physical and mental health. Attempts to restrict, challenge, or falsely characterize this potentially lifesaving care as abuse is dangerous. Such attempts block parents from making critical health care decisions for their children, create a chilling effect on health care providers who are necessary to provide care for these youth, and ultimately negatively impact the health and well-being of transgender and gender nonconforming youth.
- View OCR's guidance on gender affirming care, civil rights, and patient privacy - March 2, 2022
- Read the Statement by HHS Secretary Xavier Becerra Reaffirming HHS Support and Protection for LGBTQI+ Children and Youth - March 2, 2022
- On October 1, 2022, the District Court for the Northern District of Texas issued a judgment vacating this document. HHS is evaluating its next steps in light of that judgment but is complying with it.
As a law enforcement agency, OCR is investigating and, where appropriate, enforcing Section 1557 of the Affordable Care Act cases involving discrimination on the basis of sexual orientation or gender identity in accordance with all applicable law. This means that if people believe they have been discriminated against in a health program or activity that receives financial assistance from HHS, they can file a complaint.
Parents or caregivers who believe their child has been denied health care, including gender affirming care, on the basis of that child’s gender identity, may file a complaint with OCR.
Health care providers who believe that they are or have been unlawfully restricted from providing health care to a patient on the basis of that patient’s gender identity may file a complaint with OCR.
HIPAA and Marriage: Understanding Spouse, Family Member, Marriage, and Personal Representatives in the Privacy Rule
The HIPAA Privacy Rule contains several provisions that recognize the integral role that family members, such as spouses, often play in a patient’s health care. For example, the Privacy Rule allows covered entities to share information about the patient’s care with family members in various circumstances. It also generally requires covered entities to treat an individual’s personal representative, who may be a spouse, as the individual, for purposes such as exercising the individual’s rights under the Privacy Rule, including the right to access the individual’s health information. In addition, the Privacy Rule provides protections against the use of genetic information about an individual, which also includes certain information about family members of the individual, for underwriting purposes.
OCR has issued guidance that makes clear the terms marriage, spouse, and family member include, respectively, all lawful marriages, lawfully married spouses, and both the lawful spouses and the dependents of all lawful marriages, and clarifies certain rights of individuals under the Privacy Rule. You may find OCR’s guidance on HIPAA and marriage here: https://www.hhs.gov/sites/default/files/hipaa-and-marriage.pdf.
Resources for LGBTQI+ People
Below are United States Government resources that may be of interest to LGBTQI+ people and allies. Additional resources will be added as they are issued.
Resources from the Department of Health and Human Services
- Learn about how HHS works to ensure that LGBTQI+ people, their families, and communities receive equal access to health services by providing enhanced resources for LGBTQI+ health issues; developing better information regarding LGBTQI+ health needs; and working to close the LGBTQI+ health disparities gap that currently exists.
- Access to Healthcare: The Affordable Care Act is greatly improving access to health coverage for LGBTQ+ Americans.
- LGBTQ Youth Resources | Lesbian, Gay, Bisexual, and Transgender Health | CDC: Find resources from the CDC, other government agencies, and community organizations for LGBT Youth, their friends, educators, parents, and family members to support positive environments.
- Read the LGBTQI+ Youth – Like All Americans, They Deserve Evidence-Based Care blog from Miriam E. Deplhin-Rittmon, PhD, SAMHSA's Assistant Secretary for Mental Health and Substance Use.
- Learn about gender-affirming care and how it improves the mental health and overall well-being of gender diverse youth (OASH's Office of Population Affairs).
- Representation matters! Meet Admiral Rachel L. Levine, MD, Assistant Secretary for Health, where she fights every day to improve the health and well-being of all Americans. She's working to help our nation overcome the COVID-19 pandemic and build a stronger foundation for a healthier future - one in which every American can attain their full health potential. ADM Levine also is the head of the U.S. Public Health Service Commissioned Corps, one of the eight uniformed services.
- Read the Ryan White HIV/AIDS Program letter about the importance of gender-affirming care to effectively meet the health and medical needs of transgender people with HIV (HRSA's HIV/AIDS Bureau).
- Find technical assistance and trainings on how to build inclusive and supportive health care spaces for LGBTQI+ individuals and families (HRSA).
- Create a Safe Environment for LGBTQI+ Youth from StopBullying.gov provides resources on how to build a safe environment for all LGBTQI+ youth. Parents, schools, and communities can all play a role in preventing bullying and helping LGBTQI+ youth feel physically and emotionally safe.
- Find mental health and behavioral health resources for the LGBTQI+ community.
- The Indian Health Service (IHS) works to ensure that Lesbian, Gay, Bisexual, Transgender, Questioning and Two-Spirit (LGBTQ-2S) American Indian and Alaska Native (AI/AN) individuals and their families receive equal access to health services in the communities where they live.
- Learn about research opportunities at the National Institutes of Health’s Sexual & Gender Minority Research Office (SGMRO), which coordinates sexual and gender minority (SGM)–related research and activities by working directly with the NIH Institutes, Centers, and Offices.
Resources from the White House
- FACT SHEET: Biden-Harris Administration Advances Equality for Transgender Americans (March 31, 2022)
- White House Toolkit on Transgender Equality (June 30, 2021)
- Executive Order 13988 on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation (Jan. 21, 2021)
- Executive Order 14021 on Guaranteeing an Educational Environment Free From Discrimination on the Basis of Sex, Including Sexual Orientation or Gender Identity (March 11, 2021)
- Memorandum on Advancing the Human Rights of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Persons Around the World (February 4, 2021)
- FACT SHEET: U.S. Agencies Are Advancing the Human Rights of LGBTQI+ Persons Around the World (April 28, 2022)
Resources from the Department of Justice
- LGBTQI+ Working Group
- Memorandum on Application of Bostock v. Clayton County to Title IX (March 26, 2021)
- Letter to State Attorneys General: Federal Nondiscrimination Protections for Transgender Youth (March 31, 2022)
Resources from the Department of Education
- Resources for LGBTQI+ Students
- Notice of Interpretation - Enforcement of Title IX with Respect to Discrimination Based on Sexual Orientation and Gender Identity in Light of Bostock v. Clayton County (June 22, 2021)
Resources from the Interagency Working Group on Youth Programs (IWGYP)
If You Are, or You Know Someone Who is, in Crisis
Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates. Dial 911 in an emergency. Learn more on the Lifeline’s website or the Crisis Text Line’s website.