Human Rights Campaign Foundation's 2024 Healthcare Equality Index Reveals Policy Progress and Gaps for LGBTQ+ Inclusion in Healthcare Facilities Nationwide

This year's HEI breaks record with more than 1,000 healthcare facilities participating; NEW Interactive Map allows public to search by state for HEI-scored facilities

2024 HEI released as LGBTQ+ adults are twice as likely as non-LGBTQ+ adults to be "treated unfairly or with disrespect by a doctor or healthcare provider" in the last three years

HEI helps healthcare facilities align policies with recently finalized Biden-Harris rule to implement Section 1557 of the Affordable Care Act, prohibiting healthcare discrimination based on gender identity and sexual orientation

WASHINGTON - May 7, 2024 - Today, the Human Rights Campaign (HRC) Foundation, the educational arm of the nation's largest lesbian, gay, bisexual, transgender and queer (LGBTQ+) civil rights organization, released the 2024 Healthcare Equality Index (HEI). The HEI is the leading national benchmarking tool for LGBTQ+ inclusive policies and best practices in healthcare facilities. In its 16th iteration, 1,065 healthcare facilities nationwide participated in the scoring process the highest participation since the HEI's inception in 2007, when it had just 88 active participants. Over the years, the HRC Foundation has steadily strengthened the HEI criteria to align with best practices around inclusive LGBTQ+ healthcare. This year, 384 facilities received the top score of 100 and were awarded the designation " LGBTQ+ Healthcare Equality Leader'' and 462 earned the designation "LGBTQ+ High Performer." A new interactive map allows the public to search for LGBTQ+-inclusive facilities by state and HEI designation.

Key highlights from the report include:

• 36% of 1,065 total participants earned the designation "2024 LGBTQ+ Healthcare Equality Leader."
• Targeted Health Disparities Reduction Plans: Encouragingly, 71% have an official plan for reducing health disparities that specifically includes LGBTQ+ patients in addition to race, ethnicity, and linguistic concerns.
• Work to Be Done: Only 27% have an externally promoted specific program to provide patient navigation or advocacy services to transgender patients.
• Bias Elimination and Welcoming Interactions: Just over half (53%) have a policy or policies that specifically outline procedures and practices aimed at eliminating bias and insensitivity, and ensuring appropriate, welcoming interactions with transgender patients.
• EHR SOGI Data: Major increases are seen in the number of healthcare facilities collecting sexual orientation and gender identity-related data in their Electronic Health Records systems, which help to improve clinical care and outcomes for LGBTQ+ people. Seven of the eight relevant data points had double-digit increases.
• Pronouns in Electronic Health Records: The ability to collect and display a patient's pronouns rose from 44% to 74%. This is an important tool to help prevent misgendering a patient.
• FMLA-Equivalent Benefits: 38% offer FMLA-equivalent benefits that allow employees to take family and medical leave to care for same-sex partners as well as the children of a same-sex partner, regardless of biological or adoptive status this is up from 34% in 2022.
• Comprehensive Benefits for Domestic Partners: 41% provide medical and comprehensive health benefits to domestic partners of benefits-eligible employees up from 34% in 2022. This is the first increase in this measure since the 2015 Obergefell decision on same-sex marriage.
• Employee Resource Groups: 72% have an officially recognized LGBTQ+ employee resource group.
• Community Engagement and Support: 92% took part in or supported one or more LGBTQ+ related events or initiatives in their service area.

The impact of anti-LGBTQ+ legislation combined with a history of discrimination in healthcare settings has the potential to cause even more LGBTQ+ people to delay or avoid seeking healthcare, which makes the HEI even more salient. HRC's analysis of the 17th Annual LGBTQ+ Community Survey, fielded in 2023 with over 14,000 LGBTQ+ adults from all 50 states and Washington, DC, found that nearly 80% of LGBTQ+ adults report that state-passed gender-affirming care bans make them feel less safe, and 43% of LGBTQ+ adults reported that gender-affirming care bans impact the physical and/or mental health of themselves or their loved ones.

"As anti-LGBTQ+ extremists look to strip away healthcare access at every turn, LGBTQ+ people and their loved ones are looking for healthcare providers to offer and champion fully inclusive services, The Healthcare Equality Index is helping people find facilities where welcoming policies and practices are the standard," said Kelley Robinson, President of the Human Rights Campaign. "We know that LGBTQ+ people especially our trans family continue to face discrimination in the doctor's office. No one should have to put their health on the backburner for fear of mistreatment in a healthcare facility or by their doctor."

Alongside an onslaught of anti-LGBTQ+ healthcare legislation in some states, the Center for American Progress has reported that 30% of LGBQ respondents and 51% of transgender or non-binary respondents had encountered one or more types of mistreatment or other negative experiences with healthcare providers in the previous year, and more than 1 in 5 LGBTQ+ adults postponed healthcare treatment due to disrespect or discrimination by healthcare providers, including more than half of transgender and non-binary individuals.

"The HEI is a vital tool for assessing the state of LGBTQ+-inclusive healthcare policies and practices, and identifying areas for improvement," said Tari Hanneman, HRC's Director of Health & Aging. "The HEI is a roadmap to a world where LGBTQ+ people do not face stigma or discrimination at the doctor's office or in the hospital. A world with fewer stories like a transgender woman who a medical receptionist told that she could not use the women's bathroom or a lesbian who was stopped and rudely dismissed by a healthcare employee just for saying she was 'the other mom.' While we're encouraged by the progress that has been made across the board, it's imperative that healthcare facilities continue working towards comprehensive equity for all patients and healthcare workers. And HRC is here to help in that journey."

HEI 2024 Criteria:

Criteria 1: Non-Discrimination and Staff Training

Patient Non-Discrimination

Equal Visitation

Employment Non-Discrimination

Staff Training

Criteria 2: Patient Services and Support

LGBTQ+ Patient Services and Support

Transgender Patient Services and Support

Patient Self-Identification

Medical Decision-Making

Criteria 3: Employee Benefits and Policies

Employee Benefits and Policies

Transgender-Inclusive Health Insurance

Criteria 4: Patient and Community Engagement

Criteria 5: Responsible Citizenship

The Healthcare Equality Index is a project of the Health & Aging Program at the Human Rights Campaign Foundation. In addition to the HEI, the Health & Aging Program also operates the Long-Term Care Equality Index (LEI) in partnership with SAGE. The Health & Aging Program researches, develops, and advocates for LGBTQ+ health and aging initiatives at the federal, state, and local levels, and provides support to institutions seeking to enhance LGBTQ+ well-being via education, policy, research, and technical assistance.

For more information on the HEI and to view the full 2024 report, click here.

The Human Rights Campaign Foundation is the educational arm of the Human Rights Campaign (HRC), America's largest civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender and queer (LGBTQ+) people. Through its programs, the HRC Foundation seeks to make transformational change in the everyday lives of LGBTQ+ people, shedding light on inequity and deepening the public's understanding of LGBTQ+ issues, with a clear focus on advancing transgender and racial justice. Its work has transformed the landscape for more than 15 million workers, 11 million students, 1 million clients in the adoption and foster care system and so much more. The HRC Foundation provides direct consultation and technical assistance to institutions and communities, driving the advancement of inclusive policies and practices; it builds the capacity of future leaders and allies through fellowship and training programs; and, with the firm belief that we are stronger working together, it forges partnerships with advocates in the U.S. and around the globe to increase our impact and shape the future of our work.