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The application must be signed and notarized. Name and gender marker changes may be requested together a certified copy of a court-ordered name change is required in these cases. If the DOH denies the request to change gender designation, its decision can be appealed to a court. As of June , SSA no longer requires certification from a physician in order to update social security records to reflect a gender change.
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To change the gender marker on a social security card, a person may now submit to the SSA acceptable government-issued documentation reflecting a gender change, which includes a U. Alternatively, a person may also submit a signed letter from a licensed physician confirming that the person has had appropriate clinical treatment for gender transition, which does not have to mean surgery.
The risk of problems caused by not changing SSA records is particularly high in the context of employment. In the past, the SSA sometimes contacted an employer when it noticed that the personal information it had about a social security number usually name, but sometimes gender in its Social Security Number Verification System SSNVS did not match the information being reported by the employer. These so-called "No-Match" letters often ended up "outing" transgender employees at work. Though the SSA ended its policy of allowing employers to match the gender markers of employees with the SSNVS in , some systems used by state government agencies still match gender markers against SSA records.
Additionally, the possibility that a federal identification card system will be developed increases the likelihood that, in the near future, a person's SSA gender marker will be considered the last word on the person's gender. To change the gender marker on one's passport, a person must apply for a new passport in person at a passport acceptance facility with a completed Form DS, appropriate fees, regularly required documents, and a medical certification indicating that the person has undergone the clinical treatment appropriate to facilitate gender transition, as certified by a licensed physician who is familiar with the person's transition-related treatment.
Certification from the treating physician must include both the physician's license or certificate number, and the issuing state or jurisdiction of the medical license or certificate. No specific treatment is required, and the details of an individual's treatment e. Note that if the physician states that the individual "is in the process of gender transition," rather than stating that the individual has had appropriate clinical treatment for gender transition, the State Department will only issue a limited, two-year passport rather than the standard ten-year.
To change the gender marker on a Washington driver's license or identification card, a person must mail a written request to the Washington DOL or visit a driver licensing office location. Section of the ACA prohibits discrimination on the basis of sex by any health program receiving federal assistance, as well as within any state Health Insurance Marketplace established under the ACA. In a rule, HHS explicitly stated that under Section discrimination "on the basis of sex" includes discrimination on the basis of gender identity.
However, in December a Texas court issued a nationwide injunction to the portion of the HHS rule prohibiting discrimination on the basis of gender identity and termination of pregnancy. A recent California court decision denied a motion to stay a Section gender identity claim. The Court found that discrimination on the basis of transgender identity was protected under the ACA and that the injunction was not applicable as the Court's analysis relied on the language of the statute itself, not the enjoined HHS rule. This does not necessarily mean that Medicare will cover gender affirming surgeries for all patients, but it does mean that Medicare will no longer automatically deny claims for transition-related medical procedures.
Medicaid is a joint federal and state program for individuals and families with limited resources. As of the Washington Apple Health program covers many medically necessary surgical and nonsurgical services for transgender individuals. These include services such as transition related hormones, primary care visits, mental health visits, and various surgeries.
Working with a primary care provider and an advocacy organization may assist transgender individuals in finding surgeons willing to accept Apple Health. For public employees of Washington State, the Public Employee Benefits Board PEBB offers coverage for surgical and nonsurgical transition-related care, including hormones and gender confirming surgery. For active duty and retired armed forces members under the federal TRICARE program, only coverage for nonsurgical transition-related care is available. Thus, coverage includes hormones and mental health services, but not gender confirmation surgery.
Private health plans that are "self-insured" are often exempt from state law requirements and therefore are generally not subject to the OIC's directive requiring equality in health insurance coverage for transgender individuals. However, self-insured plans must still abide by federal and state anti-discrimination laws to the extent the laws are applicable.
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Self-insured plans are private health insurance plans for employees that are fully insured by the employer rather than by an outside insurance company, meaning the employer pays the insurance claims. Because self-insured plans often rely on outside insurance companies for administrative support, it is often difficult for employees to know whether or not their plan is self-insured. If you are not sure whether your plan is self-insured, ask your employer. Self-insured plans are primarily offered by large employers with more than employees. The Washington State Office of Insurance Commissioner OIC encourages transgender individuals who have experienced discriminatory exclusions or denials of service in private health insurance plans to file a complaint for investigation.
For information on filing a complaint with the OIC, visit www. Supreme Court held that prison officials violated the Eighth Amendment where officials showed "deliberate indifference" to ongoing physical and sexual violence against a transgender prisoner by other prisoners. Court of Appeals for the Ninth Circuit held that prison officials also violate the Eighth Amendment when officials commit acts of violence against transgender prisoners. The ACLU believes that prisons and jails may also violate the constitutional rights of transgender prisoners under the Equal Protection Clause of the Fourteenth Amendment if prison officials deny transgender individuals services or benefits because of their transgender status, when those services and benefits are provided to other prisoners.
Furthermore, the Prison Rape Elimination Act PREA , a federal law that aims to combat sexual assault and harassment in prisons and jails, provides additional support for the protection of transgender inmates.