The Human Rights Campaign Foundation released its 15th anniversary edition of the Healthcare Equality Index (HEI), the country’s foremost benchmarking survey of healthcare facilities on policies and practices dedicated to the equitable treatment and inclusion of their LGBTQ+ patients, visitors and employees. In the 2022 report, two Texas hospitals, UT Southwestern Medical Center and Children’s Health in Dallas, have had a major penalty applied to their HEI scores because they stopped providing necessary and medically approved care to transgender youth while continuing the same care for cisgender youth.

Late 2021, the GENECIS clinic at Children’s Health, which was operated jointly with UT Southwestern Medical Center, was closed. The GENECIS clinic was one of only a few clinics in the southwest providing comprehensive medically-necessary healthcare to transgender youth. Upon the clinic’s closure, the hospitals said they would cease to offer age-appropriate, medically-necessary, gender-affirming care by stopping all new prescriptions for puberty blockers and hormone therapy for transgender youth patients. In addition, the hospitals have publicly confirmed that they will continue to provide similar treatments for cisgender youth, which amounts to discrimination against transgender youth and a clear violation of their own internal Patient Non-Discrimination Policy. In response, and due to the hospitals’ unwillingness to answer questions about their decision, the HRC Foundation has applied a rarely used 25 point deduction as part of the HEI’s “Responsible Citizenship” criteria.

“The actions taken by UT Southwestern Medical Center and Children’s Health are life-threatening for transgender youth and required decisive action on our part,” said Tari Hanneman, Director of Health & Aging at The Human Rights Campaign. “Every person deserves to have access to quality healthcare, be respected and heard by their doctor, and feel safe in the facility where they are receiving care, which is why it is heartbreaking that transgender kids in Texas are being rejected this life-saving, gender-affirming care. The Healthcare Equality Index, at its core, strives to ensure LGBTQ+ people are protected and affirmed by their healthcare providers and feel safe seeking services.”

Last month, Texas Governor Abbott and Texas Attorney General Paxton took unprecedented steps to prevent transgender youth from accessing best-practice, age-appropriate, medically-necessary, gender-affirming care, in opposition to the recommendations of every major medical and mental health organization in the country — all of whom affirm the importance of gender-affirming care for transgender and non-binary people. This directive is now being challenged in courts and is currently enjoined; however, parents of transgender youth continue to fear that they’ll be accused of child abuse and have their children removed from their home, simply because they support their children receiving medically necessary care. Furthermore, Gov. Abbott’s office, along with the Texas State House Investigative Committee, pressured both hospitals to shut down the GENECIS clinic.

This year, a record 906 healthcare facilities actively participated in the 2022 HEI survey and 496 of those earned an “LGBTQ+ Healthcare Equality Leader” designation. The HEI evaluates and scores healthcare facilities on detailed criteria falling under four central pillars:

• Foundational Policies and Training;

• LGBTQ+ Patient Services and Support;

• Employee Benefits and Policies; and,

• Patient and Community Engagement.

In the 2022 report, an impressive 496 facilities earned HRC’s “LGBTQ+ Healthcare Equality Leader” designation, receiving the maximum score in each section and earning an overall score of 100. Another 251 facilities earned the “Top Performer” designation with scores between 80 and 95 points and at least partial credit in each section.

UT Southwestern Medical Center and Children’s Health were among 22 healthcare facilities in Texas that actively participated in the 2022 HEI. Only one hospital, Methodist Metropolitan Hospital in San Antonio, as well as three clinics, People’s Community Clinic, RBJ Health Center, and Vivent Health - Texas, all based in Austin, received the highly coveted “LGBTQ+ Healthcare Equality Leader” designation. The scores for all Texas participants can be found here.

The remarkable progress reflected in the 2022 HEI includes:

• 99% of HEI participants documented that they include both “sexual orientation” and “gender identity” in their patient non-discrimination policy.

• 99% of HEI participants documented that they include both “sexual orientation” and “gender identity” in their employment nondiscrimination policy.

• 81% of HEI participants offer transgender-inclusive healthcare benefits to their employees, up from 75% in 2019, which was the first year this it was required in order to obtain Leader status.
  
  

In addition to active survey participants, the HRC Foundation proactively researched the key policies for LGBTQ+ inclusion at over 1,300 non-participating hospitals. Unfortunately, these research hospitals were much less likely to have LGBTQ+ non-discrimination policies in place, which is a stark contrast to the near-perfect adoption by active participants. Among the researched hospitals in which we were able to find or obtain enumerated patient non-discrimination policies, only 70% have policies that include both sexual orientation and gender identity compared to 99% of HEI participants.