Current President Donald Trump made many promises on the campaign trail. Just a few months into his presidency, he has taken actions on several priorities, primarily through issuing executive orders. Since January 20, he’s issued 111 executive orders, according to the Federal Register.
Six of those orders explicitly name one of Trump’s promised focuses – transgender and gender non-conforming folks – and others mention gender identity. What does that mean for people in Washington state?
Across the U.S., 1.6 million people ages 13 and older identify as transgender (including those who are gender non-conforming), or about 0.6% of the population, according to a 2022 report from the UCLA School of Law Williams Institute. In Washington, currently at least 0.41% of residents are transgender, according to the World Population Review.
While transgender and gender non-conforming populations field targeted legislation from the Trump administration, Washington state provides guaranteed protections.
“Washington state remains a leader in protecting trans youth, and we will continue to act to protect the civil rights of transgender and queer people, including access to gender-affirming health care,” stated the Washington State Legislative LGBTQ Caucus in a press release.
Adrien Leavitt, a staff attorney with ACLU of Washington, agreed that Washington is among the top states in this regard, not just through the legislation, but also through the continued commitment from our government officials.
“We have really clear state protections for trans people in most every area, and we have state government leaders that are showing up and being really clear that they intend to uphold those protections,” Leavitt said in a phone interview.
While federal standards change, Washingtonians can know what to expect when it comes to state protections for their gender identity and expression.
In Washington state, gender-affirming care is legal and protected. Health insurers and plans cannot discriminate on the basis of sexual orientation or gender identity in any way, per state legislation. Insurance carriers cannot have policies barring any and all gender-affirming care.
Put simply, gender-affirming treatment includes any care prescribed to treat conditions related to gender identity, including gender dysphoria and related conditions. This includes, but is not limited to, facial procedures like facial feminization surgery, hair removal procedures like electrolysis, breast augmentation or reduction surgery, hormone therapy and mental services.
“Our state health insurance coverage covers many gender-affirming care procedures, more than just HRT [hormone replacement therapy], and that’s been a big change in Washington,” Leavitt said.
Insurers and health plans cannot deny or limit gender-affirming care coverage for anyone when the care is medically necessary, consistent with the person’s gender identity, and follows medically accepted care standards. Numerous factors are considered in determining if these criteria are met, and age can be considered. Additionally, gender-affirming care cannot be grouped under blanket statements like “cosmetic care” in order to deny care considered medically necessary.
Gender-affirming care (meeting the above criteria) can only be denied or limited for Washingtonians if a health care provider with experience prescribing/delivering such care has reviewed their case and confirmed there is an appropriate medical reason for the denial, per this legislation.
Health care providers are not required to offer gender-affirming care services “for conscience or moral reasons,” but they must refer patients to timely alternatives for services they do not offer.
These restrictions apply to health plans through the state Health Care Authority, Medicaid, and most other plans aside from self-funded options.
No matter where you live in the state, it is the responsibility of your health insurance carrier to make sure timely, accessible treatment is available to you, including case management support for securing out-of-network care if no options are available in your area.
People walk on the crosswalks at Washington and Fifth Avenue in downtown Olympia on Saturday, June 3. City officials led a commemoration event for Pride Month and the crosswalks painted the colors of the transgender flag. tvinson@theolympian.com /Ty Vinson Washington state’s Shield Law
The benefits of gender-affirming care protections go beyond Washington state residents, though. Anyone who visits the state seeking such services is protected from civil and criminal actions in other states where such care is restricted or criminalized, through Washington’s Shield Law.
“The Shield Law means that the state of Washington wouldn’t be able to share information that’s not protected under HIPAA, so extraneous information with the investigating state, to shield providers or parents, or depending on the age the person getting the care, from other state investigations,” Leavitt said.
This means that if a minor from Idaho was prescribed medically necessary gender-affirming care consistent with their gender identity that followed accepted care standards, they could come to Washington for that care despite Idaho’s current ban. They would be protected from investigation by Idaho authorities, and from any civil or criminal action against them for receiving said care.
The state’s Shield Law prohibits Washington’s courts, law enforcement, state and local agencies, and Washington-based companies or private entities from complying with other state’s legal processes related to gender-affirming care provided legally per Washington’s laws. This means police departments in Washington could not make an arrest on behalf of Idaho departments, nor could our local agencies provide information for Idaho investigations.
This law was put into action in 2023 when the Attorney General of Texas attempted to obtain records from a Washington children’s hospital.
“Those records were not turned over because of the Washington state Shield Law, mostly,” Leavitt said.
Updating identity documents in WA
Washington also has protections regarding identity documents.
Trump issued an executive order on the first day of this term mandating the federal government recognize people only by their assigned sex at birth. The State Department has suspended X gender markers on passports and is requiring new applicants to use the sex listed on their birth certificate. Currently valid passports with an X gender marker for non-binary and other gender non-conforming folks will remain valid until their expiration, according to the State Department.
Leavitt told McClatchy the ACLU of Washington is seeing passports with X gender markers treated as valid. However, they have also seen some update requests cause passports to be sent back with reverted gender markers.
“Obviously that’s a huge change, and really alarming and problematic,” Leavitt said.
On top of simply disregarding transgender and gender non-conforming identities, these federal updates complicate travel for transgender and gender nonconforming Washingtonians.
Both the federal and state government handle a variety of different identification documents. By changing federal guidelines, federal identification may not match state identification. At this time, ACLU of Washington hasn’t seen issues with passports being accepted, but contradicting documents may cause issues. Additionally, this effectively outs any trans person to the security personnel.
“We know that’s dangerous, any time a trans person interacts with systems of policing, and that includes border security, we know that that’s a moment of profound risk for trans people, particularly for trans women and particularly for trans women of color, who are at higher risk in these situations,” Leavitt said.
A 2024 report from ACLU found numerous disparities in the way LGBTQ+ populations are treated by police, particularly transgender people. More than one in four trans people reported experiencing physical force from police. An earlier study from the Williams Institute found that queer people of color and transgender/gender non-conforming folks reported higher rates of police abuse and misconduct.
All things considered, this creates a high level of fear around traveling for the transgender and gender non-conforming community. A person’s willingness to travel is impacted by how safe they feel.
“There is just so much fear, and that fear has a profound impact on trans people and the trans community,” Leavitt said.
A coalition of 12 attorneys general, including Washington’s Attorney General Nick Brown, submitted a letter to the Department of State opposing such changes.
“The proposed changes to these forms will conflict with state laws; cause significant confusion, increase costs, and undermine state public safety interests; interfere with the rights of our transgender, nonbinary, and intersex residents to travel freely; and expose our transgender, nonbinary, and intersex residents to harm, including harassment, discrimination, and negative mental health outcomes,” the letter states.
Washington state allows adults to change the gender on their driver’s license and birth certificate to M, F or X without medical documentation. Minors can also update their gender on such documents, if they have parent/guardian consent and health care provider confirmation.
While this process could previously take months to be completed, Governor Bob Ferguson posted last month that a backlog of requests had been addressed, and now requests should take around three days.
A step-by-step process for updating your name and gender on identification documents in Washington state, including birth certificates and driver’s licenses, is available through the Greater Seattle Business Association, the largest LGBTQIA+ and allied member chamber of commerce in North America.
Gender protections in Washington schools
Along with recommended practices for administrators and teachers, the Washington State Office of the Superintendent of Public Instruction (OSPI) offers guidance for many gender inclusive policies for schools in the state. This includes requirements on inclusive curriculum.
Schools cannot discriminate against students based on their gender identity or expression. Students in Washington state have the right to be treated in accordance with their gender identity and express their gender as desired while at school, according to the OSPI. They also have the right to receive education free from harassment and bullying.
Additionally, OSPI protects the privacy of a student’s confidential health information. Public school staff has complex guidelines for student privacy relating to their transgender or gender non-conforming status. In general, they cannot share a student’s health information with others unless given the student’s permission or required by law.
While there is currently a proposal to change the WIAA policy on transgender athlete participation, which allows students to compete in programs that align with their most consistent gender identity, the OSPI has made its stance on the matter clear.
“OSPI has been very clear about the right of trans girls to participate in girls sports, and I think has really been a leader in that,” Leavitt said. He clarified that the same goes for trans boys in boys sports, but trans girls are often the target of athletic restrictions.
The 2024 Capital City Pride Parade makes its way down Capitol Way in Olympia on Sunday, headed from the state Capitol Campus to Heritage Park on Capitol Lake. Steve Bloom/The Olympian Transgender protections in Washington
Here are some other miscellaneous protections in Washington law:
- Conversion therapy is banned in the state, and it is considered unprofessional conduct for a health care provider to perform conversion therapy on a patient under 18.
- Health care providers and their families are protected from threats and harassment for performing gender-affirming care through the Washington Address Confidentiality Program.
- To protect queer youth estranged from their family, licensed youth shelters cannot contact the parents/guardians of youth seeking gender-affirming care at their shelter, and instead must contact the Department of Children, Youth and Families within 72 hours of their arrival.
- You can report violations of any of these laws. Who you contact depends on the violator, according to a recent document from the Attorney General’s Office:
- For health insurance violations, you can contact the Office of the Insurance Commissioner at 800-562-6900 or online at insurance.wa.gov/consumer-complaint-center-contact-us; the Washington State Human Rights Commission at 800-233-3247 or online at wahum.my.site.com/FileaComplaintOnline; or the Attorney General’s Office at 800-551-4636 or online at atg.wa.gov/contactus.aspx.
- For health insurance violations for Medicaid, PEBB and SEBB subscribers, contact the Health Care Authority’s ADA Coordinator at 855-682-0787, compliance@hca.wa.gov or online at support.hca.wa.gov/hcasupport.
- For violations related to public schools, contact the Washington State Office of the Superintendent of Public Instruction’s Equity and Civil Rights Office at 360-725-6162.
- For general discrimination violations, contact the Washington State Human Rights Commission at 800-233-3247 or online at wahum.my.site.com/FileaComplaintOnline.
Gender resource groups in Washington
There are resource groups for transgender and gender non-conforming Washingtonians all over the state. Some are statewide, some have chapters in different regions of the state, and some offer localized services.
For example, PFLAG is a national LGBTQ+ organization with several chapters in Washington. Local chapters have been hosting safe space hangouts, education sessions, and resource events with notaries and identification update applications, expedited marriage certificate assistance and other timely resources.
Statewide resources include:
- ACLU Washington
- Equal Rights Washington
- QLaw Foundation
- Gender Justice League Northwest
- Lavender Rights Project
- Northwest Washington Gender Alliance
- Northwest Network
- Gender Diversity
Additionally, national databases like the LGBTQ Health Care Directory and Refuge Restrooms include location-based information in Washington.
