Progressive healthcare providers say recent HHS rules banning discrimination against transgender people raise more questions about how to adequately serve that community.
Previously, civil rights laws enforced by HHS' Office for Civil Rights were based specifically on race, color, national origin, disability and age.
The recent rules clarify that civil rights protections will further block discrimination based on sex, which the agency says includes gender identity.
The rules apply to any provider or program that accepts federal dollars and carries out the anti-bias provisions of the Affordable Care Act.
Insurers will not be required to cover gender transition treatments like surgery. But they could face questions if they deny medically necessary services related to gender transition.
In larger states, like California and New York, which have relatively stringent anti-discrimination laws, industry stakeholders say they need more guidance for discrimination gray areas.