The entire University of California at San Francisco system, including UCSF Medical Center, has installed hundreds of new signs on single-occupancy restrooms to identify them as gender-inclusive. Old signs with pictograms of a man, woman or family have been replaced with gender-neutral signage.
“By removing traditional gender barriers, we improve spaces to be safe and welcoming to everyone,” said Jon Giacomi, executive director of UCSF facilities.
With a clinic that provides mental and physical care to transgender children and teens, UCSF is not an unwelcoming place, by any means. But starting Monday, it and any other provider, healthcare organization or insurer in the U.S. that accepts federal funding are required by an HHS rule to adhere to new protocols when dealing with transgender patients.
In May, HHS finalized a rule that protects transgender patients from being discriminated against because of their gender or gender identity. Beginning July 18, transgender people should be able to enter bathrooms or hospital wards consistent with their gender identity.
The rule does not explicitly require insurers to cover gender-transition treatments such as surgery. But insurers could face questions if they deny medically necessary services related to gender transition. Insurers may have to tweak claims forms to allow persons to identify as one gender and receive services for the opposite sex. For example, an insurer may be required to cover a mammogram for a transgender man.
Hospitals in Boston, New York and San Francisco say their local anti-discrimination laws have made it easy to follow the new rule.
Boston's Brigham and Women's Health Care, for example, is ahead of the game, says a spokesperson. The hospital has been providing training in patient-centered transgender care, has transitioned to nongendered bathrooms, and its electronic health record allows patients to self-identify as transgender. All of this makes it easier to assign inpatient rooms based on the patient's preferred gender.
Mount Sinai Health System in New York City also took these steps, said Barbara Warren, the director for LGBT programs and policies at the system's office for diversity and inclusion.
She has heard that many hospitals are working hard to adapt and not just because HHS is mandating it.
“A lot of healthcare systems want to attract transgender patients,” Warren said. “There is competition in healthcare for patients, and a lot of healthcare systems need to be able to offer equitable and competent care to diverse patient populations."
An estimated 0.5% to 2% of the U.S. population has transgender feelings, and 0.1% to 0.5% have taken steps to transition to another gender.
But not all hospitals may be ready, said Tari Hanneman of the Human Rights Campaign.
In March, the Human Rights Campaign found that just 21% of U.S. hospitals it surveyed had specific policies outlining procedures and practices to eliminate bias and insensitivity toward transgender patients.
Advocates say they're willing to give noncompliant hospitals the benefit of the doubt.
“Some hospitals still haven't heard of the rules, and unfortunately, there is still a great deal of discrimination that occurs against transgender people,” said Ma'ayan Anafi, policy counsel at the National Center for Transgender Equality.
To that end, organizations like the Human Rights Campaign and the Fenway Institute in Boston, which develops health programs for gay, lesbian, bisexual and transgender people, have been hosting training events and webinars on how to improve care for transgender individuals.
Still, there will be some unwilling to change. Some religious hospitals say the rule is restrictive. During the comment period, the Catholic Health Association wrote that, “Health services related to gender transition present a potential conflict with the equally important principle of the free exercise of religion.”
That argument is similar to those made in several lawsuits brought by religious organizations that say compliance with rules and laws related to providing birth control or paying for abortion through health plans go against their religious freedom.
But at least some are saying their affiliations won't result in noncompliance.
“We will follow the law and do what we are required to do,” said Gale Smith, a spokeswoman for Houston Methodist.
Noncompliance carries steep consequences. The rule empowers HHS to suspend or terminate federal funding to any outlier. HHS may also contact the Justice Department to determine if there's been a criminal offense.
But it's unlikely any hospital would ultimately walk away from hundreds of millions in federal reimbursement, Hanneman said. HHS did not offer a blanket religious exemption.