The National Coalition for LGBT Health

2012 Year-end Report to Members and Stakeholders

The National Coalition for LGBT Health (Coalition) is pleased to present the following report on our many and substantive 2012 accomplishments. We wish to thank our members, peer organizations, allies, funders, our board and staff for contributing to these collective successes. Together, we moved ever closer to a more just health paradigm and a more affirming, holistic, and inclusive health care system.

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2013 is setting up to be another consequential year in this work, as key provisions of the Affordable Care Act come into effect and as fiscal priorities affecting every federal department, including HHS, are negotiated. We must therefore preserve and build on the gains we’ve made in recent years to ensure that LGBT health equity remains a national priority. That’s why our vision is more relevant than ever:

Lesbian, Gay, Bisexual, Transgender, and Queer individuals, families, and communities are thriving in a society that values their vast contributions to the human landscape, celebrates their hard-won victory for full enfranchisement, and follows their determined lead in a collective pursuit of ever-improving health and wellness. Accordingly, health and wellness programs and services are imbued with a respect for the dignity and worth of LGBTQ people and will provide them with high-quality, comprehensive, equitable, and culturally responsive programs and services.

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The following report summarizes our work in seven key areas:         

• Affordable Care Act
• Regulatory and Invited Comments
• Other Federal Administrative Advocacy
• Veterans Health Administration
• The LGBT Behavioral Health Initiative
• Legislative Advocacy
• Health Awareness Week

Affordable Care Act

• The Coalition led a campaign in which 18 national LGBT organizations issued a joint statement in the hours following the Supreme Court’s June 28 decision to uphold the Affordable Care Act (ACA). Disseminated to 52 journalists and bloggers, as well as thousands of LGBT health stakeholders, the statement was part of the Coalition’s ongoing commitment to highlighting LGBT health needs and ensuring that LGBT health equity remains at the center of ACA implementation efforts in Washington and across the country.

• In the days following the statement release, the Coalition, in partnership with the GLMA and CenterLink, held a national call on the Court’s decision. A panel of LGBT advocates (Joseph Jefferson, Senior Policy Associate, National Coalition for LGBT Health; Patrick Paschall, Policy Advocate, the Task Force; and Harper Jean Tobin, Policy Counsel, National Center for Transgender Equality) engaged nearly 60 stakeholders from across the country in a conversation about the implications for LGBT health and to consider ways to preserve and expand LGBT non-discrimination protections as the ACA is being implemented in the States.

• Three weeks following the decision, the Coalition, undertaking another critical organizing effort, convened a meeting of LGBT health movement advocates and three allied organizations: the Center for American Progress, Families USA, and National Health Law Program to discuss our respective ACA implementation strategies and priorities, as well as to help start a dialogue about how all the parties can pool advocacy resources to greater effect. From the perspective of the LGBT health movement, these new partnerships hold great promise on two fronts: First, it is important that our allies integrate LGBT concerns into their larger ACA implementation advocacy efforts. Second, because these allies have the resources necessary to wage national advocacy campaigns, LGBT health advocates must have a seat at those organizing “tables”.

• In August, the Coalition introduced a web-based community action toolkit. The “LGBTQ Advocates’ Guide to ACA Implementation” is a toolkit that provides advocates and consumers a one-stop shop for the most essential ACA resources, including state-by-state analyses, FAQs, and reports on ACA basics, Medicaid expansion updates, Essential Health Benefits, and the Health Insurance Exchanges.

• The week following the November election, at the Coalition’s annual meeting, the Board and membership affirmed that a majority of the Coalition’s near-term efforts should be directed toward ensuring an LGBT-affirming ACA implementation framework, both at the federal and state level. Coalition members are now forming workgroups to advance these efforts in 2013 and beyond.

Regulatory and Invited Comments

Stage 2 Meaningful Use

The Coalition in May submitted comment on whether the recording of gender identity (GI) and/or sexual orientation (SO) should be included within the Stage 2 criteria that eligible providers must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. [The Coalition acknowledges the National Center for Transgender Equality, a Coalition member, and the Center for American Progress for their work in crafting the comment.] The letter broadly addresses LGBT health disparities, the Institutes of Medicine recommendations, benefits of including data (providers take accurate health histories and family resources); providing preventive care, research on LGBT health, tracking LGBT disparities, and the need to stratify data on patient populations.

Ryan White 2013 Reauthorization

The Coalition in July submitted comment to the Health Resources Services Administration on the forthcoming 2013 reauthorization of the Ryan White Care Act. By 2014, when key provisions of the Affordable Care Act go into effect, many people now receiving Ryan White Program services will begin receiving care through newly-expanded Medicaid programs or a health exchange. While this will likely ensure a steady source of care in the long run, the transition period leading to this new service delivery system may also disrupt access to supportive or adherence services. These include transportation services, food and nutrition products and services, linguistics, and housing support, among others. Moreover, Medicaid or the health exchanges may lack some necessary basic service sand coverage of critical HIV medications. The Coalition’s comment centered on the following nine goals:

1)    Ensure program stability during ACA implementation and beyond

2)    Support implementation of the National HIV/AIDS Strategy

3)    Preserve flexible funding

4)    Ensure quality of care

5)    Intensify focus on reducing disparities in health care access

6)    Provide technical assistance to HIV/AIDS service organizations

7)    Block efforts to include a sunset provision

8)    Collect meaningful data

9)    Repeal distinction between core medical services and supportive services

SAMHSA Uniform Block Grant Application

The Coalition in September submitted comment to the Substance Abuse and Mental Health Services Administration, a division of HHS, on a newly combined uniform application for Mental Health Block Grant and Substance Abuse Block Grant, the goal of which was to hold states to a higher standard, as they plan, deliver, and track LGBT-inclusive programs.

Further, to ensure that LGBT population needs are factored into these combined applications, the Coalition has been engaged in ongoing advocacy with SAMHSA, pressing for articulated guidance to states. For the first time, SAMHSA enumerated LGBT populations in the proposed block grant revisions that were published in the Federal Register on October 10. In addition, SAMHSA issued its first-ever guidance to states on the means by which they should integrate LGBT population needs into their program design and planning, staring in FY 2014-2015.

Designating LGBT as a Medically Underserved Population

In November, the Coalition sent a letter to HHS Secretary Sebelius, asking HHS to designate LGBT as a Medically Underserved Population. The Coalition has played a crucial role in the convening of the negotiated rulemaking committee in 2010 to assist the Department of Health and Human Services in revising the medically underserved population (MUP), medically underserved area (MUA), and health professional shortage area (HPSA) designations that underlie the Federally Qualified Health Center program and other federal and state health care access programs. Coalition members provided numerous public comments during the committee’s deliberations and worked closely with Dr. Elisabeth Wilson, a committee member, to bring issues of priority concern for LGBT communities to the committee’s attention.

The Secretary responded with a letter to the Coalition, reaffirming the Department’s commitment to improving designation methodologies and promising that an interim final rule is forthcoming.

Other Federal Administrative Advocacy

The Coalition, together with the organizations represented on the New Beginning Initiative health team, has since January 2012 secured important changes to policies under the purview of the Department of Health and Human Services (HHS), including:

• The Agency for Healthcare Research and Quality (AHRQ) in its 2011 National Healthcare Disparities Report included for the first time the LGBT population as a priority population.

• HHS has established a policy in the new health insurance exchanges that bans discrimination based on sexual orientation and gender identity. On November 20, it announced that additional sub-regulatory language will be issued to clarify related oversight and enforcement mechanisms to ensure that these protections will function as intended.

• Healthy People 2020 released the following developmental objective for the Lesbian, Gay, Bisexual, and Transgender Health topic area:
  • LGBT 1.1 (Developmental) Increase the number of population-based data systems used to monitor Healthy People 2020 objectives that include in their core a standardized set of questions that identify lesbian, gay, and bisexual populations.
  • LGBT 1.2 (Developmental) Increase the number of population-based data systems used to monitor Healthy People 2020 objectives that include in their core a standardized set of questions that identify transgender populations.

Veterans Health Administration

Working closely with Lisa Red, Director of Cultural Competency and Communications in the newly-established Veterans Health Administration (VHA) Office on Health Equity, the Coalition has been pressing for adoption of key policy recommendations contained in its VHA Policy Analysis. The recommendations deal broadly with anti-discrimination and anti-harassment policy, family definitions, cultural competency training, visitation policy, etc. 

In February, the Coalition convened a meeting between the VHA LGBT Health Equity Workgroup that Lisa chairs and the Coalition’s VHA advocacy partner organizations. At this meeting, advocates had an opportunity to address our policy priorities and to field questions from Workgroup members. The utility of this exchange was most evident in the Workgroup’s subsequent report to Dr. Robert L. Jesse, the VHA’s Principal Deputy Under Secretary for Health. In that report, the Workgroup presented a set of 15 LGBT-inclusive policy recommendations that closely mirror those contained in the Coalition’s Policy Analysis. With Dr. Jesse’s full backing, the recommendations were taken up by the VHA’s National Leadership Committee in May. Since then, the VHA has made other LGBT-inclusive advancements, including:

• For the first time, the VHA’s forthcoming "Patient and Community Living Center   Resident Rights and Responsibility" (applicable to residents in long-term care facilities) and the "Family Member Rights & Responsibilities” policies will include non-discrimination protections based on sexual orientation and gender identity.

• Two recently formed committees—the Transgender Clinical Education Committee and the Lesbian, Gay, and Bisexual Education Committee—continue to evaluate clinical care practices to ensure that transgender and LGB veterans are receiving clinically appropriate care and to identify additional care standard enhancements. The Committees have recently launched a webinar series to promulgate best practices to VA clinical staff across the country.

• The VHA has stepped up efforts to encourage all VA medical and health facilities to participate in the Healthcare Equality Index. (The HEI is a project housed at the Human Rights Campaign that judges a healthcare facility’s policies and practices against a rigorous set of benchmarks and, once a hospital demonstrates it has met these benchmark, confers HEI certification.) The VHA leadership has devised a series of incentives to ensure compliance with the HEI benchmarks and will be adjusting those incentives as needed to effectively increase HEI participation among VA facilities.

• The Department of Veterans Affairs Principal Deputy Under Secretary for Health Dr. Jesse will soon disseminate a memo to all VA facilities requiring them to adopt three initiatives to advance LGBT culturally competent care/services. The three initiatives can be selected from among the following categories: the HEI; LGBT-inclusive policy revisions; cultural competency education; LGBT outreach; LGBT-inclusive clinical interventions; LGBT-inclusive research; and special emphasis programs.

The LGBT Behavioral Health Initiative

The Coalition in early 2012 launched the LGBT Behavioral Health Initiative (BHI), project that seeks to identify and implement both short and long-term strategies for translating LGBT-inclusive behavioral health policy, competency training and theory into practice wherever behavioral services are delivered. To this end, the BHI centers on two key objectives: 1) Enhance and expand LGBT Substance Abuse and Mental Health Cultural Competency; and 2) Develop and implement strategic partnerships.

Objective 1:

Enhance and Expand LGBT Substance Abuse and Mental Health Cultural Competency

The BHI team is working with the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop recommendations for revising  “A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals”, a provider and trainer curriculum published by The Addiction Transfer Center Network and funded by SAMHSA. Released in 2001, the trainer’s curriculum is long-overdue for revisions to ensure that behavioral health professionals are informed about and able to incorporate best practices in LGBT-affirming programs and services.

Joseph Jefferson, working with Dr. Warren and Dr. Ed Craft, SAMHSA Lead GPO and Activities Coordinator for Methamphetamine, recruited seven master trainers to help develop specific recommendations for updating the Curriculum. The trainers have provided specific recommendations that will be sent to SAMHSA by the end of December. SAMSHA will incorporate these recommendations into the reprinted edition of the curriculum in early 2013.

Objective 2:

Develop and Implement Strategic Partnerships

The BHI team is collaborating with the two principle national associations to which the States’ chief behavioral health program directors and commissioners belong – the National Association of State Alcohol and Drug Abuse Directors (NASADAD) and the National Association of State Mental Health Program Directors (NASMHPD) –  to ensure that state and local-level behavioral health programs and services are prepared to include LGBT-specific population targets in their Substance Abuse Prevention and Treatment Block Grant (SABG) and the Community Mental Health Services Block Grant (MHBG) applications. In addition, following meetings with Sr. Policy Associate Joseph Jefferson and the BHI project advisor, Dr. Barbara Warren, NASADAD has agreed to finalize and disseminate a member survey it conducted in late 2011 on a range of LGBT-related programs and services. As of this writing, we are still waiting for the survey’s release. We will then assess the survey’s findings and determine the implications it has on our future NASADAD member engagement strategy.  The BHI team continues to work with NASMHPD to organize a forthcoming Coalition-sponsored webinar. The webinar will help provide information and resources to NASMHPD members on how to effectively respond to the LGBT-focused Guidance issued by the Substance Abuse and Mental Health Services Administration as part of its newly-streamlined block grant program.

Legislative Advocacy

The Coalition – in partnership with the Family Equality Council, Center for American Progress, Human Rights Campaign and GLMA – held house and senate-side Congressional briefings in March to educate Hill staffers on the health and well-being of LGBT Families. The briefings highlighted the day-to-day hurdles LGBT families face in accessing health insurance, health care, fair tax treatment , hospital visitation and medical decision-making – as presented in “Obstacles and Opportunities: Ensuring the Health and Wellness for LGBT Families”, a report co-authored by the Movement Advancement Project, Family Equality Council, and Center for American Progress in partnership with the Coalition.

We continue to support Coalition the efforts of Coalition members Services for GLBT Elders (SAGE) and HRC to press for reauthorization of a more LGBT-inclusive Older Americans Act, the Tax Parity for Health Plan Beneficiaries Act, and the Healthy Families Act.

Health Awareness Week

Earlier this year, the Coalition coordinated the 10^th Annual LGBT Health Awareness Week, a nation-wide campaign that challenges community members, advocates, service providers, and government officials to recognize health and wellness as an essential part of the social justice movement for lesbian, gay, bisexual, and transgender individuals, families and the wider community.  Over 10,000 printed items were distributed by more than 200 organizations across the United States.  Events were sponsored in a variety of locations from LGBT Community Centers to Veterans Administration Hospitals. In addition, the Coalition, in partnership with the Family Equality Council, Center for American Progress, Human Rights Campaign, Gay and Lesbian Medical Association, and the Movement Advancement Project, produced a report on the health of LGBT families, “Obstacles & Opportunities: Health & Wellness for LGBT Families”. Lastly, the Coalition held a national call to commemorate LGBT Health Awareness Week that featured Dr. Mary Wakefield, Administrator at the Health Resources and Services Administration.