Medicaid plays an important role in providing health insurance coverage to lesbian, gay, bisexual, and transgender (LGBT) adults. This issue brief uses data from the National Health Interview Survey (2015-2018), the National Survey on Drug Use and Health (2015-2019), and the U.S. Transgender Survey (2015) to examine two aspects of access among LGBT populations. The first set of analyses focus on the experiences of Medicaid-covered lesbian, gay, and bisexual (LGB) populations with accessing physical and behavioral health services compared to Medicaid-covered heterosexual adults. The second set of analyses compare the experiences of Medicaid-covered transgender and gender-diverse (TGD) populations to those covered by private insurance and those without insurance coverage.
We found that the majority of Medicaid-covered LGB adults had a usual source of care and similar rates of physical health care service use as Medicaid-covered heterosexual adults. However, LGB adults were significantly more likely than heterosexual adults to report having a mental illness or a substance use disorder and to report not having received needed behavioral health or alcohol and drug treatment in the past 12 months.
We found that TGD adults covered by Medicaid reported similar rates of access to providers for both routine and most gender-affirming health care as those covered by private insurance, but those covered by Medicaid were more likely to report not being able to find in-network providers to provide gender affirming surgery. Additionally, a higher proportion of those covered by Medicaid compared to those with private insurance reported having negative experiences with their providers, such as having to teach their provider about TGD people to get the appropriate care.