NADE Responds to NDF on Equitable Access to SSA Disability Programs for LGBTQIA+ Communities

NADE Correspondence

National Disability Forum – Engage SSA

Equitable Access to SSA Disability Programs for LGBTQIA+ Communities

February 17, 2022 (MS Teams Conference)

Request for Participation and Pre-Conference Response:

1. What are challenges LGBTQIA+ adults face when accessing healthcare?  Some younger individuals left home due to unsupportive home environments. Therefore, they have little to no financial resources to access healthcare. Often, they are homeless or “couch surfing” to get by. Until they find access to organizations that provide free care or organizations that are designed for easy access by the LGBTQ community, they go without care of any type. Even then, they may not be able to access more specialized care due to expense or lack of insurance.

Being misgendered, misidentified, or attacked due to your sexual or gender identity causes very significant mental health consequences which are often minimized. Transgender individuals may also spend many years convincing their doctors of their need to transition and are first given many stigmatizing mental health diagnoses before they are given an option to transition. This is based upon outdated “WPATH SOC” standards of care, which require psychological signs of for any treatment in a way that no one seeking other procedures would need to obtain. In other areas of care, patients are assumed capable of giving their own consent unless there is an actual indication otherwise.

It’s also thought that some providers in health care may be prejudiced if they are conservative with their beliefs. When it comes to healthcare, people limit what they share with providers, mostly out of fear. 

Finally, insurance programs willing to cover some aspects of gender reassignment are not willing to cover the full transition leaving many people stuck in between the gender they are, and their gender assigned at birth. There is no uniform standard.

2. What challenges do LGBTQIA+ adults face when accessing SSA programs? Knowledge of available assistance is the biggest challenge. The applications are very exclusive of the trans community. The gender options built into the system gives only binary options; they don’t offer any options to self-identify as anything other than assigned at birth, and particularly no option to identify as non-binary, gender fluid, etc. Trans individuals may be unsure what they can/should choose.  Similarly, there are limited options to provide preferred names or pronouns.

SSA assumes sex=gender in their application and do not ask these separately. Applicants are unable to communicate their preferred pronouns.

SSA also requires a court order for a name change and there are no uniform standards for this from state to state or county to county. Some locations require an FBI background check which can be very stressful while others require only a notarized statement from community members

3. What are some issues surrounding self-attestation of sex and gender markers and what are some possible solutions? Individuals who are looking to make these changes expect to be faced with bias and challenges. LGBTQIA+ individuals may encounter some with religious or other biases that interfere with obtaining quality jobs or care. If the LGBTQIA+ individuals knew that they would encounter allies or members of the LGBTQ community in public settings, this would process would be less stressful. An SSA representative working with the community to facilitate this type of change or education in the facilities where LGBTQIA+ should feel “safe”, i.e., their medical care providers, AIDS outreach organizations, PRIDE events, etc.  The best solution is employee training.

Separating gender from sex would allow individuals to get the services they need to advance through transitioning without the need for the frequent appeals required for surgery approval. SSA should also offer opportunities for applicants to provide preferred names and pronouns. To fully understand and prepare for interactions with applicants, it would be helpful to know the preferred pronouns, and preferred names.

4. What types of issues do LGBTQIA+ individuals encounter when looking for work or attempting to reenter the work force? Although there are allies for the community, there is still an overwhelming number of individuals who do not accept the LGBTQ community, so they are not hired for positions based on these biases. If they are hired, some experience prejudice from coworkers and other employees or bullying. Although it is illegal to making hiring decisions on protected class information, Right-to-Work states do not require reason to dismiss someone, which as a result, can disguise the discrimination.

When applying for jobs, choosing either “male or female”, can be very intimidating for those who are transitioning or identify as non-binary.  LGBTQIA+s constantly live in fear of employers who may portend conflicts within the ranks, or with customers, if an LGBTQIA+ individual is hired.

Background checks generally require multiple years of history. Since the process of transitioning is extensive, this means that people are often forced to use multiple names at the same time, as different programs require A to change first and so on. This carries over to professional fields, where individuals may have published work under a prior name and/or have their credentials disregarded. Licensing for many professions also requires mental health clearance. The therapy requirement for transitioning individuals or others coping with identity concerns results in some LGBTQIA+ individuals to be excluded from these fields completely.

5. What are the best practices when collecting data on sex and gender?  It would depend on the reason the information was needed. In our world today, we are working on treating everyone equally no matter what sex/gender they are. Collect it only when necessary.

It can be very confusing knowing how to address someone as is it still a very touchy situation for some people. For SSA the best practice is to treat each applicant equally. What may be helpful to all is to be educated about the use of pronouns and the socially accepted pronouns. Allow the use of “other” categories and they/them pronouns.

Also, understand that sex and gender are not the same thing. Applications should allow for both. Do not force individuals to choose a title such as “Ms.” Or “Mr.” Even if we must use legal names on some documents, we can still allow a preferred name for other types of communication, such as phone calls or letters.

Respectfully Submitted 2/04/2022, by

Marjorie E Garcia

NADE President