What Rights Do Trans Teens Have In The U.S.?

When it comes to teens, coverage of transitioning surgery and general care by health insurance is a major concern. However, coverage of these needs isn't automatically required by law; in fact, some states actually have explicit laws banning Medicaid from being applied to transitioning health needs ( Wyoming is an example, as is Tennessee). The National Transgender Rights Center has an illuminating map of which states have laws on private and public health coverage and how they apply to transgender patients.

Even the Affordable Care Act has certain limits, as Healthcare.Gov explains: "Your health insurance company can’t limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity, or recorded gender — for example, a transgender man who has residual breast tissue or an intact cervix getting a mammogram or pap smear," but "many health plans are still using exclusions such as 'services related to sex change' or 'sex reassignment surgery' to deny coverage to transgender people for certain health care services. Coverage varies by state." The Affordable Care Act's Section 1557 is a non-discrimination clause that forbids any health entity, from those receiving federal funding (like hospitals or Medicaid) to the federal insurance marketplace, from discriminating on the basis of protected characteristics, including gender; but we're not sure how long that will stay in place.

Oddly, while Tennessee has an LGBT hate crimes law in place, it has nothing whatsoever on the books that makes it illegal for private health insurers to discriminate against trans kids, nor anything that bans insurers from "excluding coverage for transgender-specific care." That's the case across a lot of states; only a handful of left-leaning ones, like Illinois, New York, California and Vermont, have specific laws on their books forbidding this kind of discrimination. Absence of laws, when it comes to transgender teens, can be as big a problem as negative laws.

Identity documents, particularly birth certificates and driver's licenses, are incredibly legally important for transgender teens. As the National Center for Transgender Equality people notes, "Trans people need accurate and consistent IDs to open bank accounts, start new jobs, enrol in school, and travel," but the process of obtaining them is often hugely burdensome and expensive. Again, there are no federal laws in place to protect transgender teens here.

The state-based laws regarding getting one's correct gender on identity documents vary when it comes to what "proof" is required. Lambda Legal points out that many states actually require a letter from a surgeon that confirms gender-affirming surgery, though "California, the District of Columbia, Iowa, New York City, New York State, Oregon, Vermont and Washington State have removed surgical requirements completely for those applying to change a birth certificate."

The difficulty is compounded by the different kinds of identity documents available to US teens, as well as the different standards applied to them within the same state. Birth certificates, driver's licenses and name change documents can have vastly different legal procedures and statuses at the same time. The right to name changes, for instance, is often deeply complicated. As the Guardian noted in November 2016, while reporting on a Georgia judge's refusal to honor a transgender man's request to change his name, many states have laws on the books regulating name changes, which were created to protect against fraud — but these laws can also allow courts to closely monitor or even forbid the name changes of transgender individuals. Some states, like Kansas, have laws on the books allowing shifts in gender identity on driver's licenses, but forbid it on birth certificates.

Interestingly, the process for obtaining passports is the same nationwide, but it's still not quite the same in every case. If you want to get a passport (which you can in the US from the age of 16, or younger if accompanied by an adult), there are two types available: a 10-year one if you "have had appropriate clinical treatment", or a 2-year one if you "are in the process of getting appropriate clinical treatment." When it comes to defining what "appropriate clinical treatment" is, they leave it up to the discretion of your doctor, who has to submit a letter about your treatment, but they do make it clear that "surgery is not a requirement."

This is likely to be one of the avenues through which the Trump administration's new "guidelines," if they are formally issued, will be fought. The ACLU's review of transgender rights across the US notes that there are actually a wide variety of states with specific laws on the books that protect transgender students from bullying, but the specific breadth of those laws and where they apply differs from state to state:

"Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, New Jersey, New York, North Carolina, Oregon, Vermont, Washington, and the District of Columbia have state laws that specifically protect transgender students in public schools from harassment and/or discrimination. Some of these state laws explicitly apply to education, while other states (including Colorado, Delaware, Illinois, Maine, New Jersey, Nevada, Vermont, and Washington) include public schools in their bans on gender identity discrimination in public accommodations. In Colorado, Illinois, Maine, Nevada, New Jersey, and the District of Columbia, gender identity discrimination laws also cover some or all non-religious private schools."

The Obama administration and the courts, as we've seen, interpreted Title IX as a federal protection for transgender teens in schools, but the National Center of Transgender Equality reports that the Department Of Education's Office of Civil Rights is temporarily suspended from investigating any complaints by adolescents that they're being discriminated against in an educational environment.