Content requested: Sexual identity and gender identity
Agency:

Office of Minority Health
Center for Medicaid and CHIP Services
Federal Coordinated Health Care Office
Centers for Medicare & Medicaid Services (CMS)
U.S. Department of Health and Human Services (HHS)

Use description:

Data at the census block or individual level would help the above
offices understand and improve care for the subpopulations of
Medicare, Medicaid, and dual Medicare-Medicaid (federallyinsured) enrollees who are lesbian, gay, bisexual, or transgender
(LGBT). Collection of these data through Census programs would
be beneficial to future data collection efforts by CMS. Given that
the Census Bureau is a leader in developing innovative data
collection methods, this activity would ostensibly lead to similar
data collections by other federal agencies. This activity would
enable CMS and other federal agencies to link critical
demographic data and address important questions related to
health equity.
The availability of nationally representative and quality data will
be essential to improve the unique health and social challenges of
federally insured LGBT populations. Despite LGBT people having a
greater risk of being low income and having a disability, there are
limited federal data sources available that demonstrate the
existence of health disparities by sexual identity and gender
identity.
The Affordable Care Act invests in the implementation of a new
health data collection and analysis strategy for multiple
demographic groups.
Section 1557 of the Affordable Care Act indicates that individuals
“shall not … be excluded from the participation in, be denied
benefits of, or be subjected to discrimination under, any health
program or activity, any part of which is receiving Federal financial
assistance” based on race, color, national origin, sex,1 or disability

1

Recent clarification by the Departments of Education and Department of Justice have determined that Title IX of
the Education Amendments of 1972 prohibition on sex discrimination encompasses discrimination based on
gender identity. Recent EEOC decisions have held that discrimination against an individual because of that person’s
sexual orientation is discrimination because of sex and therefore prohibited under Title VII of the Civil Rights Act of
1964.

 status. To date, the lack of information on sexual and gender
identity prevents the study of whether sexual and gender
minorities are experiencing discrimination in the receipt of CMS
services.
Section 2602 of the Affordable Care Act established the CMS
Federal Coordinated Health Care Office (FCHCO). One of the
statutory goals of FCHCO is to “improve the quality of health care
and long-term services for dual eligible individuals.” Without
information on sexual and gender identity, FCHCHO will be
disadvantaged in fulfilling this goal for federally insured LGBT
individuals.
Section 4302 of the Affordable Care Act contains provisions to
strengthen federal data collection efforts by requiring that all
national federal data collection efforts collect information on
race, ethnicity, sex, primary language, and disability status. Recent
administrative actions have expanded sex to include gender
identity. The law also provides the Department of Health and
Human Services (HHS) the opportunity to collect additional
demographic data to further improve our understanding of
healthcare disparities. In the past, identifying disparities and
effectively monitoring efforts to reduce them has been limited by
a lack of specificity, uniformity, and quality in data collection and
reporting procedures. Consistent methods for collecting and
reporting health data will improve our understanding of the
nature and extent of health disparities experienced by members
of LGBT community.

Legal citation:

-

Section 1557 of the Affordable Care Act (Pub. L. 111-148; 42
U.S. Code § 18116)
Section 2602 of the Affordable Care Act (Pub. L. 111-148; 42
U.S. Code § 1315b(c)(3))
Section 4302 of the Affordable Care Act (Pub. L. 111-148; 42
U.S. Code § 300kk (2)(e))

Lowest level of
geography needed:

Census block [Individual-level data preferred]

Frequency:

Annually