ISSUE BRIEFS

DELIVERING COMPREHENSIVE CARE

Comprehensive care for LGBTQ+ communities extends far beyond gender-affirming care and includes inclusive primary care, mental health services, and social support. However, many healthcare providers are not adequately trained to care for LGBTQ+ individuals, making it difficult to address their unique health needs, especially when access to affirming providers is limited. While care accessibility is shaped by many factors, it remains a persistent issue across the United States.

Healthcare access is challenging for many Americans, particularly those living in rural areas or with low incomes, but these barriers are compounded for gender-diverse individuals. Rural communities face shrinking numbers of providers and hospitals, limited insurance coverage, and transportation challenges (1,2). More than three million LGBTQ+ Americans live in rural areas, and their ability to access care is increasingly impacted by restricted choices in health services and providers (1,3). Although urban areas tend to have more healthcare providers, finding affirming care remains difficult, and many LGBTQ+ patients continue to experience stigma within healthcare settings (4).

Cost is another major barrier to care in the United States, leading many patients to delay or forgo necessary services. According to 2025 data from KFF, 51% of LGBTQ+ adults delayed or canceled needed care due to cost, compared to 34% of non-LGBTQ+ adults. Among LGBTQ+ adults who postponed care, 25% reported subsequent declines in health, compared to 18% of non-LGBTQ+ adults (5). These data underscore how financial barriers disproportionately affect LGBTQ+ patients, compounding challenges related to provider availability and affirming care. 

Several strategies can help improve access to affirming, reliable care through both local and digital interventions. Consistent social support is essential (1). Peer advocacy, mentorship, and locally organized Pride or community events help foster connection and reduce isolation. When in-person opportunities are limited, virtual spaces play a critical role. Online platforms such as TrevorSpace, community-based Facebook groups, and national or local hotlines enable LGBTQ+ individuals, particularly those in rural areas, to build supportive networks and access crisis resources (6,7).

Healthcare services can also be expanded through mobile and pop-up care models. Van-based clinics and temporary care sites bring gender-affirming care, primary care, and mental health services directly to communities that otherwise lack access. Equally important is ensuring that clinicians nationwide receive appropriate training in gender-affirming care and working with diverse populations. Telehealth further expands access by allowing counseling, follow-up visits, and certain aspects of gender-affirming care to be delivered remotely when in-person services are unavailable (8).

Transportation remains a significant barrier as rural healthcare infrastructure continues to erode. State and local governments can improve access to in-person care through targeted investments that do not require full-scale public transit systems. Hospital shuttles, gas vouchers, and ride-service discounts can help individuals overcome geographic obstacles when traveling long distances for care (9).

Massachusetts offers one example of an innovative policy response through its Affirming Health Care Trust Fund, which is designed to cover the cost of transgender health services in the event that federal funding is eliminated (10). While Massachusetts has implemented several policies that protect LGBTQ+ individuals, resulting in better health outcomes than states with anti-LGBTQ+ legislation, health disparities persist (11,12). This underscores the need for continued efforts, including expanded provider training and cost-offsetting measures. 

Barriers to affirming healthcare for LGBTQ+ people are systemic, intersecting with cost, provider availability, and stigma within medical settings. Improving access to comprehensive care demands intentional policy action, including expanded provider training, innovative service delivery, and protections that reduce financial burden. Strengthening these supports is critical to improving health outcomes and ensuring dignity and equity for LGBTQ+ patients across the United States.

References

  1. Movement Advancement Project. Where We Call Home: LGBT People in Rural America. Published online April 2019. https://www.lgbtmap.org/file/lgbt-rural-executive-summary.pdf

  2. How is the federal funding landscape affecting rural health? UC Berkeley Public Health. October 29, 2025. Accessed December 29, 2025. https://publichealth.berkeley.edu/articles/news/commentary/how-is-the-federal-funding-landscape-affecting-rural-health

  3. O’Connor B, Phelon K, Price B, et al. LGBTQIA+ health in rural America. Published online February 2022. https://www.ruralhealth.us/getmedia/6589dfad-a5f9-494e-b0e8-749f8b60ff68/2022-NRHA-LGBTQ-Policy-Paper-Final-%281%29.pdf

  4. Montero A, Hamel L, Artiga S, Dawson L. LGBT Adults’ Experiences with Discrimination and Health Care Disparities: Findings from the KFF Survey of Racism, Discrimination, and Health. KFF. April 2, 2024. Accessed December 29, 2025. https://www.kff.org/racial-equity-and-health-policy/lgbt-adults-experiences-with-discrimination-and-health-care-disparities-findings-from-the-kff-survey-of-racism-discrimination-and-health/

  5. Dawson L, Lopes L. Health Care Access and Financial Barriers Among LGBT People Amidst Looming Health Care Cuts. KFF. July 17, 2025. Accessed December 29, 2025. https://www.kff.org/health-costs/health-care-access-and-financial-barriers-among-lgbt-people-amidst-looming-health-care-cuts/

  6. TrevorSpace - Community for LGBTQ young people. Accessed December 29, 2025. https://www.trevorspace.org/

  7. Support Hotlines. PFLAG. Accessed December 29, 2025. https://pflag.org/resource/support-hotlines/

  8. Hadland SE, Yehia BR, Makadon HJ. Caring for LGBTQ Youth in Inclusive and Affirmative Environments. Pediatr Clin North Am. 2016;63(6):955-969. doi:10.1016/j.pcl.2016.07.001

  9. Guo J, F. Bard J, J. Morrice D, Jaén CR, Poursani R. Offering transportation services to economically disadvantaged patients at a family health center: a case study. Health Syst (Basingstoke). 11(4):251-275. doi:10.1080/20476965.2021.1936658

  10. Salvatore A. State Makes Moves to Protect Transgender Care. The Provincetown Independent. July 9, 2025. Accessed December 29, 2025. https://provincetownindependent.org/local-journalism-project/2025/07/09/state-makes-moves-to-protect-transgender-care/

  11. Movement Advancement Project | Snapshot: LGBTQ Equality by State. Accessed December 29, 2025. https://www.lgbtmap.org/equality-maps

  12. Viveiros C. The Report: LGBTQ+ People in Massachusetts - Fenway Health. June 4, 2025. Accessed December 29, 2025. https://fenwayhealth.org/event/the-report-lgbtq-people-in-massachusetts/