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Healthcare Laws and Policies

This map reflects state laws or administrative policies which explicitly include, explicitly exclude, or have no clear policy covering transition-related or gender-affirming care for transgender people who are state employees as part of their state employee health benefits.
United States Map
  • State explicitly includes gender-affirming care in its state employee health benefits (24 states + D.C.)
  • State does not mention or has no clear policy regarding gender-affirming care in its state employee health benefits (12 states, 5 territories)
  • State explicitly excludes gender-affirming care from its state employee health benefits (14 states)

Citations & More Information
*Green states with an asterisk cover transgender-related medical care but may require preauthorization or pre-approval for receiving it.
*In both Florida and South Carolina, the states exclude coverage of medical care for transgender people from its state employee plans, but in both states there are also appellate court decisions that ruled such exclusions unconstitutional. There are still ongoing lawsuits however.  Click the "Citations & More Information" button beneath the map legend for more detail about this and every state.
*Oklahoma has multiple plans available to state employees. According to TLDEF's research, two of these plans have explicit exclusions; one has no policy either way; and one has no policy, but the provider (Blue Cross) has its own policy that includes gender-affirming care. However, because this is a Blue Cross policy and not an Oklahoma policy, and the state has multiple other plans with exclusions, Oklahoma is coded here as having exclusionary plans. Please see TLDEF's research for more detail, or click "Citations & More Information" beneath the map legend for more detail about every state.
*In West Virginia, an April 2024 ruling from the 4th Circuit Court of Appeals found unconstitutional the state's previous exclusions of transgender-related care in its state plans, but the decision is being appealed. This map will be updated as the case progresses.

Recommended citation:
Movement Advancement Project. [Year of access]. "Equality Maps: Healthcare Laws and Policies." https://www.mapresearch.org/equality-maps/healthcare_laws_and_policies. Accessed 03/26/2025. 

Percent of Adult LGBTQ Population Covered by Laws

*Note: These percentages reflect estimates of the LGBTQ adult population living in the 50 states and the District of Columbia. Estimates of the LGBTQ adult population in the five inhabited U.S. territories are not available, and so cannot be reflected here.

55%

55 % of the LGBTQ population lives in states that explicitly include gender-affirming care in its state employee health benefits

18%

18 % of LGBTQ population lives in states that do not mention or has no clear policy regarding gender-affirming care in its state employee health benefits

27%

27 % of LGBTQ population lives in states explicitly exclude gender-affirming care from its state employee health benefits

Data current as of 03/26/2025
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