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HUMAN RIGHTS CAMPAIGN BLUEPRINT FOR POSITIVE CHANGE 2020
2 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
EXECUTIVE SUMMARY
In January 2021, the Biden administration will
Blueprint for Positive Change 2020 is inherit a Presidency and executive branch
a comprehensive list of 85 individual nearly unrecognizable from the administra-
policy recommendations aimed at tion he left behind in 2016. As the COVID-19
improving the lives of LGBTQ people. crisis continues its stranglehold on the
Recommendations include:
nation’s health and economy, the Trump
Ensure consistent administrative administration has continued its coordinated,
implementation of Bostock v. Clayton systemic attack on our nation’s most sacred
County across all agencies enforcing institutions—our courts, our Constitution,
civil rights statutes and provisions; and our foundational civil rights statutes.
The Biden administration will be tasked with
Revise restrictions on transgender
confronting this damage to our nation’s civic
individuals to return to an inclusive
infrastructure, but must also look to the fu-
policy of military service;
ture. Joe Biden has an incredible opportunity
Establish an interagency working group to advance policies to improve the lives of
to address anti-transgender violence; LGBTQ Americans through the public health
Appoint openly-LGBTQ justices, lens required by the pandemic. In the Blue-
judges, executive officials and print for Positive Change 2020, the Human
ambassadors; Rights Campaign has identified a list of more
than 85 individual policy recommendations
Establish uniform data collection
for the new administration.
standards incorporating sexual
orientation and gender identity into
Since taking office, the Trump administration
federal surveys;
has consistently targeted far reaching regulatory
Establish an interagency working group changes that undermine the rights of vulnerable
to protect and support LGBTQ rights communities, including those who are LGBTQ. The
globally; administration consistently mischaracterizes the
End discrimination against gay and law in federal regulations, legal memorandums, and
bisexual blood donors; litigation actions. These coordinated attacks on
civil rights exploit the public’s traditionally limited
Prohibit the practice of conversion
engagement with federal legal actions and admin-
therapy as a fraudulent business
istrative developments, violating the public trust.
practice;
And, with the Trump administration undermining
Rescind and replace regulations the rights of the LGBTQ community at home, it has
restricting coverage of Section 1557 of made it impossible for the U.S. to lead with authority
the Affordable Care Act; and on protecting the human rights of LGBTQ people
Eliminate discrimination against abroad. The Biden administration must unravel these
beneficiaries in charitable choice and harmful regulations across Departments, reinstitute
faith-based initiatives. the strong protections championed by President
Obama, and put the U.S. back on the path toward
equality for all LGBTQ people.HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 3
However, we have been here before. When HRC first people at home and abroad. While each would make
published the Blueprint for Positive Change in 2008, a demonstrable improvement in the lives of LGBTQ
it contained a collection of 54 individual policy rec- people, here we highlight a few. We believe that
ommendations many of which were so fundamental it is essential that federal judiciary and executive
that they seem to represent a more dire age. Don’t offices reflect the diversity of the country and the
Ask, Don’t Tell was still on the books; tourists and appointment of openly LGBTQ individuals sends a
immigrants living with HIV were categorically exclud- vitally important message to the LGBTQ community,
ed from entering the United States; and transgender including youth, about their equal ability to serve
workers could still be legally fired by the federal their country at the highest levels of government. We
government simply because of their gender identity. urge the administration to appoint qualified LGBTQ
The Obama administration worked to systematically judges, executive officials, and ambassadors abroad,
dismantle this discriminatory infrastructure of federal and to strive to appoint the first-ever openly LGBTQ
inequality that has plagued the LGBTQ community cabinet secretary. Equally important, all appointed
since this country’s founding. The heart of this work judges must be dedicated to upholding the consti-
could never be undone. In fact, the Biden adminis- tutional principle of equality in order to ensure that
tration will have the opportunity to begin enforce- the civil rights of all people, including the LGBTQ
ment of Bostock v. Clayton County in earnest across community, are protected.
the federal government. The Blueprint for Positive
Change 2020 is designed to offer a road map for We urge the administration to end taxpayer-funded
the next administration to restore the federal com- discrimination once and for all and to rescind Trump-
mitment to this critically important work. backed policies that invite discrimination against
LGBTQ people by federally funded grantees and
The COVID-19 pandemic has exposed the systemic contractors. We call on the federal government to
gaps in equality across populations—particularly take real, tangible steps to ensure that every patient
vulnerable communities especially Black and Latinx receiving care through a federally funded health
communities. We find ourselves at a crossroads. Too program has access to the respectful, comprehen-
many LGBTQ Americans continue to lack explicit sive care to which they are entitled, including PrEP
legal protections under federal law. State-sanc- and transition-related care, and we urge the admin-
tioned and state-funded discrimination continues istration to focus on solutions to finally achieve an
to degrade individual dignity and prevents many AIDS-free generation. Stigma and violence against
families from developing the stability and financial our community—especially transgender women of
security that are essential to success. LGBTQ young color—must be systematically addressed. We also
people continue to face discrimination and harass- recognize that it is crucial that the United States
ment at school and long after classes have let out. remain a safe harbor where LGBTQ people can
As a target for bias-motivated violence, our com- escape persecution abroad.
munity has also fallen victim to the epidemic of gun
violence that plagues our nation. Too many LGBTQ These are just a few examples of the common sense
people continue to pay an unacceptable price for proposals and recommendations included in the
simply being themselves. Blueprint for Positive Change 2020. Each one is
essential to improving the lives of LGBTQ people
The Blueprint for Positive Change 2020 is a com- and cementing our near decade of progress towards
prehensive list of more than 85 individual policy equality. We recognize the tremendous work there is
recommendations, reaching across the federal gov- to be done in every corner of this nation and we are
ernment, aimed at bettering the daily lives of LGBTQ ready for the challenge.4 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
RECOMMENDATIONS
WHITE HOUSE/EXECUTIVE Appoint Openly-LGBTQ Justices, Judges,
AND INTERAGENCY ACTIONS Executive Officials, and Ambassadors
The federal judiciary, executive offices, and ambassa-
dorships should reflect the diversity of the country. The
Ensure Consistent Administrative appointment of openly-LGBTQ individuals sends a vital-
Implementation of Bostock v. Clayton ly important message to the LGBTQ community, includ-
County Across All Agencies Enforcing Civil ing youth, about their equal ability to serve their country
Rights Statutes and Provisions at the highest levels of government. The administration
On June 15, 2020, the Supreme Court held that should appoint a diverse array of qualified judges,
Title VII of the Civil Rights Act of 1964 prohibits executive officials, and ambassadors, including LGBTQ
discrimination on the basis of sexual orientation, people and people from other marginalized commu-
gender identity, and transgender status as unlawful nities. The administration should strive to appoint the
sex discrimination. The White House should ensure first-ever openly-LGBTQ cabinet secretary and the first
a uniform, government-wide implementation of this openly lesbian, bisexual, or transgender ambassador.
decision, including by instructing the Department of
Justice and other federal agencies to withdraw any Commit to Diversity in Hiring Across the
guidance or regulations that are inconsistent with Federal Government
the Court’s holding. Government employees should reflect the diversity of
the country. The administration should commit sufficient
Establish an Interagency Working Group to resources and efforts to hire, retain, and promote a
Address Anti-Transgender Violence diverse workforce, including LGBTQ people and people
Rates of violence against transgender people have from other marginalized communities. This commitment
reached epidemic proportions. Since 2013, HRC should be inclusive of all agencies and all positions.
and other advocates have tracked more than 180
cases of anti-transgender fatal violence across Establish Uniform Data Collection Standards
more than 33 states, the District of Columbia, and Incorporating Sexual Orientation and Gender
Puerto Rico. This epidemic disproportionately im- Identity into Federal Surveys
pacts Black and Brown transgender women, who The collection of accurate, complete data is essen-
comprise approximately 4 in 5 of all anti-transgen- tial to ensure that federal programs and policies are
der homicides. The administration should establish meeting the unique needs of the LGBTQ community.
an interagency working group to identify solutions However, there are currently no uniform standards for
to the root causes of anti-transgender violence data collection based on sexual orientation and gen-
and develop a plan to implement policy changes. der identity across federal agencies. In the absence of
This working group must listen to and collaborate accurate data, policy makers do not have information
with Black and Brown transgender women before needed to create the appropriate policies and services
and during the development of solutions to erad- LGBTQ people need. The White House should require
icate violence, and maintain communication to federal agencies to develop and incorporate uniform
determine if the solutions are working and what demographic data forms designed to gather data
needs to be changed. based on sexual orientation and gender identity.HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 5
Ensure that Providers Participating from discrimination on the basis of religion, includ-
in Federal Health Programs Provide ing requiring organizations to notify beneficiaries of
Information Regarding PrEP and their rights. The Trump administration revised these
Other HIV and STI Prevention Tools regulations across nine agencies, stripping away these
Although federal health programs including TRI- safeguards and notice requirements for beneficiaries.
CARE, Medicare, and Medicaid cover preventive care, These regulations must be rescinded and revised to
many healthcare providers fail to consistently identify ensure that the government does not discriminate
patients at the highest risk of contracting HIV. The on the basis of religion, religious affiliation, or lack of
Departments of Health and Human Services, De- religious affiliation in making government grants or
fense, and Veterans Affairs, which administer federal contracts and that grants and contracts continue to
health programs, must ensure that providers are be issued based on merit. The administration should
aware of their obligation to provide complete infor- also affirmatively clarify that the statutes containing
mation regarding preventive care including PrEP and charitable choice provisions in no way preempt federal,
other proven HIV and STI prevention tools. state, or local laws preventing discrimination on the
basis of sexual orientation or gender identity.
End the Global Gag Rule
The Global Gag Rule, also known as the Mexico Establish an Interagency Working Group to
City Policy, bars any U.S. aid to foreign non-govern- Protect and Support LGBTQ Rights Globally
mental organizations (NGOs) that provide abortion Support for LGBTQ rights globally has suffered under
information, referrals, or services even when the the Trump administration. The administration should
NGO provides those services with alternate funds. recreate an interagency working group to coordinate
Prior iterations of the Global Gag Rule were limited efforts aimed at building upon and implementing the
to U.S. funding for family planning services. Under 2011 Presidential Memorandum “International Initia-
the Trump administration, it now affects all U.S. tives to Advance the Human Rights of Lesbian, Gay,
international health funding, including funding for Bisexual, and Transgender Persons.” In addition, the
children’s health, HIV/AIDS, malaria, and tuberculo- working group should provide support for enactment
sis. The Global Gag Rule must be ended in all forms. of a policy directing that LGBTQ rights be included
consistently and deliberately in public diplomacy.
Eliminate Discrimination Against
Beneficiaries in Charitable Choice Revoke the Trump Executive Order
and Faith-Based Initiatives Limiting Diversity Training
In recent years, the federal government has increas- The Trump administration issued an executive order
ingly turned to religious organizations to provide vital attacking diversity and inclusion practices of federal
services to vulnerable populations. These include agencies, federal contractors and recipients of federal
substance abuse treatment, early childhood education, grants. The EO prohibits these entities from engag-
food and nutrition assistance, job training, and home- ing in diversity and inclusion training programs that
less shelters. Faith-based groups often have expertise address serious problems including white privilege,
in these areas as well as strong ties to the commu- systemic racism, unconscious bias, and intersectional-
nities they serve. The charitable choice regulations ity. As a result, may agencies and recipients of federal
guide how religious organizations operate and engage funding have eliminated or suspended diversity and
with federally funded services and programs. Initially inclusion programs due to fears about complying with
adopted in 2004, these regulations were revised in the order. The White House should immediately revoke
2015 to provide greater protections for beneficiaries the executive order.6 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
Promote and Protect the Rights individuals and increase their risk of discrimination,
of LGBTQ People in U.S. Foreign harassment, and violence. Inaccurate agency records
Assistance Programs can also impede transgender individuals’ ability to
U.S. foreign assistance programs provide vital participate in vital federal programs. For instance,
support and resources to combat HIV and other Medicare or Medicaid coverage may be automatically
diseases and work to promote human rights for denied for services that appear inconsistent with an
all people. The U.S. government should enact a individual’s Social Security Administration gender
comprehensive, consistent policy preventing foreign marker records, and incorrect Department of Edu-
assistance from going to contractors, subcontrac- cation student aid records can lead to loan servicer
tors, or grantees that advocate against the human issues that impede a borrower’s ability to consolidate
rights of LGBTQ people, or that discriminate against loans, enter repayment, and start earning Public
LGBTQ people in the provision of services and in Service Loan Forgiveness credit. It is also crucial for
their employment practices. This should apply to all federal employees to be able to easily update their
U.S. agencies funding international development Office of Personnel Management employee records
work, including USAID, the Departments of State, so they can bring their full authentic selves to work.
Agriculture, Treasury, and others. Furthermore, agencies that issue important federal
identification documents, including passports, green
Ensure Elimination of Barriers and Improve cards, and naturalization certificates, have differ-
Systems to Support LGBTQ Refugees and ing and restrictive processes for correcting gender
Asylum Seekers markers. The administration should ensure that every
The Trump administration has made gaining relevant federal agency has a gender maker update
asylum nearly impossible and has vastly reduced process in place that is streamlined, free from un-
the number of refugees provided resettlement necessary barriers, and includes a non-binary gender
in the U.S., from over 100,000 in 2016 to less marker designation.
than 20,000 today. These changes leave count-
less lives vulnerable to violence, persecution, and Include Sexual Orientation and
even death. In 69 countries, same-sex sexual Gender Identity Data in Federal
activity is a criminal act that results in isolation, Injury Surveillance Systems
imprisonment, and in some countries even the Most national death and injury surveillance systems
death penalty. In addition, transgender individuals lack metrics on both sexual orientation and gender
encounter additional obstacles. The administration identity, making it incredibly difficult to ascertain the
should take steps to restore the asylum process full extent of the impacts of gun violence on LGBTQ
in the U.S. and restore our nation’s commitment to people. The lack of this data also impedes the de-
resettle refugees from around the world. velopment and implementation of evidence-based
interventions to address gun violence affecting
Modernize the Gender Marker Update LGBTQ communities. The administration should
Process for Federal Records and ensure that all existing national injury data systems
Identification Documents collect detailed firearm involvement information as
Most federal agencies that maintain records on well as data on the sexual orientation and gender
individuals or issue identification documents have identity of victims and suspects. This includes, for
unnecessarily restrictive requirements for updating instance, the Department of Health and Human
one’s gender marker. Unmatched federal records Services’s National Vital Statistics System, National
and identification documents can out transgender Intimate Partner and Sexual Violence Survey, andHUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 7
Healthcare Cost and Utilization Project; the Depart- DEPARTMENT OF DEFENSE
ment of Justice’s National Incident Based Reporting
System and Supplementary Homicide Reports; and End Discrimination Against HIV-Positive
the Department of Transportation’s National EMS Individuals From Enlistment, Appointment,
Information System. and Deployment
Currently, the Department of Defense (DOD) Direc-
tive 6485.01 prohibits any person who is HIV-posi-
DEPARTMENT OF AGRICULTURE tive from enlistment, appointment, or deployment in
the military. This bar on service is severely outdated
Prohibit Discrimination Against LGBTQ and grounded in medically inaccurate information
Participants in Assisted USDA Programs and that does not reflect the standard of care utilized by
Services Including Nutrition Support Programs the medical community. DOD should amend Direc-
Federal programs serve millions of people nation- tive 6485.01 removing the categorical ban.
wide and across the economic-spectrum. Nondis-
crimination provisions are crucial to ensuring equal Revise Restrictions on Transgender
access to federally funded services. The Depart- Individuals to Return to an Inclusive Policy
ment of Agriculture (USDA) administers critical pro- of Military Service
grams such as the Special Supplemental Nutrition In June 2016, the Department of Defense (DOD)
Program for Women, Infants, and Children (WIC) announced that transgender individuals would finally
and the Supplemental Nutrition Assistance Program be able to serve openly in the U.S. military, lifting
(SNAP), commonly known as “food stamps.” USDA the decades-old discriminatory ban preventing them
should implement rules and provide guidance to en- from doing so. However under the Trump administra-
sure that discrimination against LGBTQ participants tion, DOD halted this policy, disallowing transgender
is prohibited in programs and services that receive servicemembers from serving in the military. Under
assistance from USDA. this ban, a medically designated need to transition
gender is a basis for discharge and denial of acces-
sion even if the servicemember can still meet general
DEPARTMENT OF COMMERCE standards for readiness and deployment. The admin-
istration should revise the regulations implementing
Add LGBTQ Questions on the American this ban to again allow transgender servicemembers
Community Survey and Next U.S. Census to serve openly in the military.
Currently, there are no questions regarding sexual
orientation or gender identity on the United State’s Ensure All LGBTQ Military Personnel
two largest demographic data collection efforts: Have Access to PrEP Without Jeopardizing
the ongoing American Community Survey and the Job Status
decennial U.S. Census. Demographic data from The Department of Defense (DOD) must ensure
these surveys is used to direct hundreds of billions military personnel have access to PrEP without fear
of dollars in federal funding annually. The absence of discrimination or retaliation. DOD should amend
of information regarding LGBTQ people negatively its existing guidance to ensure that discrimination
impacts support for the LGBTQ community. The against LGBTQ military personnel is prohibited and
Census Bureau should add sexual orientation and ensure access to and confidentiality of personnel
gender identity questions to both the American who choose to use PrEP and other HIV/STI preven-
Community Survey and next U.S. Census. tion tools.8 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
Ensure Active Duty Servicemembers Have accrediting bodies to accredit religious institutions
Equal Access to Spousal Housing that discriminate or that do not meet science based
The Department of Defense (DOD) Instruction curricula standards. The Department of Educa-
1100.16 provides DOD’s Equal Opportunity in Off- tion should issue a regulation clarifying that this
Base Housing policy, which ensures equal oppor- provision, which requires accreditation agencies
tunity housing for off-base personnel consistent to “respect the stated mission” of religious institu-
with federal law. The Fair Housing Act prohibits tions, does not require the accreditation of religious
discrimination on the basis of sex, which includes institutions that do not meet neutral accreditation
discrimination on the basis of sexual orientation and standards including nondiscrimination policies and
gender identity. DOD should issue a new instruction scientific curriculum requirements.
adding a definition of “sex discrimination” to include
discrimination on the basis of sexual orientation Ensure the Enforcement LGBTQ Students’
and gender identity to be consistent with the Fair Rights Under Title IX
Housing Act. Title IX of the Education Amendments Act of 1972
prohibits discrimination based on sex in federally
Ensure Access to Comprehensive funded education programs. The scope of Title
Transition-Related Care for Dependents IX’s sex discrimination provisions have tradition-
of Military Personnel ally been interpreted in accordance with Title VII,
The Department of Defense (DOD) provides health- which the Supreme Court has held includes sexual
care via TRICARE to all military personnel and orientation and gender identity. However, the
their dependents. TRICARE policy includes transi- Departments of Education and Justice eliminated
tion-related care for military family members and Obama-era guidance clarifying that schools must
retirees. Military medical facilities provide hormone treat transgender students consistent with their
treatment and counseling for transgender military identity. This encourages school officials to permit
personnel and their dependents; however, medical- harassment of transgender students, deny access
ly necessary gender affirming surgery is explicitly to facilities consistent with gender identity, and
prohibited in TRICARE’s new policy. To ensure that refuse to use correct names and pronouns—all
every dependent has equal access to the services inflicting untold emotional harm. The Depart-
funded by DOD, including medically necessary ments should take affirmative steps to ensure that
gender affirming surgery, DOD must amend the schools understand their obligations to LGBTQ
current policy to remove the categorical prohibition students with a particular focus on transgender
of coverage for gender affirming surgery. students. The Department of Education should
encourage students who have experienced sexual
orientation or gender identity discrimination to file
DEPARTMENT OF EDUCATION complaints, then investigate and resolve com-
plaints through all appropriate channels.
Ensure Nondiscrimination Policies
and Science Based Curricula Are Not Ensure Student Surviviors of Sexual
Undermined by Religious Exemptions to Harassment and Assault are Protected
Accreditation Standards The Trump administration issued a regulation mak-
Language regarding accreditation of religious insti- ing it more difficult for student survivors of sexual
tutions of higher education in the Higher Education harassment and assault to report their abuse and
Opportunity Act could be interpreted to require promoting policies that favor their abusers. LGBTQHUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 9
people are disproportionately affected by sexual leges and universities have requested an exemption
assault and harassment, and the stigma that many from Title IX with regards to LGBTQ students. Stu-
LGBTQ people face can make it more difficult for dents should have the ability to know which schools
survivors to report. The Department of Education have claimed a right to discriminate against them in
should issue a revised regulation to ensure students advance of applying for admission. ED should issue
who have experienced sexual harassment assault a regulation mandating that colleges and univer-
are fully supported and protected by educational sities once again request exemptions, and provide
institutions, and that regulation should be fully inclu- public notice of their request for and receipt of a
sive of LGBTQ students. religious exemption. In addition, ED should provide
a publicly available list of colleges and universities
Prohibit Pupil Services Personnel from that have received religious exemptions.
Engaging in Conversion Therapy or Referring
Students to Conversion Therapy Restore Gender Identity as
Conversion therapy includes a range of harmful and Enumerated Characteristic for
discredited practices that seek to change a person’s Purposes of Tracking Bullying
sexual orientation or gender identity. Currently, Transgender youth experience bullying at higher
there is no federal law or regulation that prohibits rates than their cisgender peers as demonstrated
pupil services personnel, including school counsel- by the Department of Education (ED) conducted
ors, social workers, and other school-based mental Civil Rights Data Collection (CRDC) for the years
health professionals, from providing or referring that gender identity data were collected. The Trump
students to providers of conversion therapy. The administration revised the CRDC to eliminate gen-
Department of Education (ED) should issue rules der identity, gender expression, and nonconformity
clarifying that pupil services personnel in feder- with gender stereotypes. Consistent with the Bos-
ally funded schools who directly provide or refer tock decision, ED should restore inclusion of gender
students to providers of conversion therapy are identity, gender expression, and nonconformity with
engaging in discrimination on the basis of sex in gender stereotypes for purposes of collecting data
violation of Title IX of the Education Amendments related to bullying.
of 1972. Further, ED should prescribe rules requir-
ing schools that receive ED grants for the direct
or indirect support of pupil services personnel to DEPARTMENT OF HEALTH AND
implement policies prohibiting student services staff HUMAN SERVICES
from providing or referring students to providers of
conversion therapy. Reinstate Regulation Prohibiting
Discrimination Against LGBTQ Beneficiaries
Mandate Public Notice for Receipt of HHS Grants and Programs
of Title IX Religious Exemptions by Federal programs serve millions of people nation-
Colleges and Universities wide and across the economic spectrum. Non-
Title IX of the Education Amendments of 1972 discrimination provisions are crucial to ensuring
allows religious colleges and universities to be ex- equal access to federally funded services. The
empted from nondiscrimination requirements on the Department of Health and Human Services (HHS)
basis of sex. Until recently, the college or university oversees a wide range of programs from the Low
had to affirmatively seek an exemption from the Income Home Energy Assistance Program to the
Department of Education (ED). Some religious col- Public Health Preparedness and Response Pro-10 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
gram. HHS should begin enforcement of the 2016 Revise Conditions of Participation to Include
regulation prohibiting discrimination in all HHS pro- Nondiscrimination Requirements for All
grams on the basis of sexual orientation and gender Hospitals, Nursing Homes, and Assisted
identity and rescind the revisions proposed in 2019 Living Facilities Participating in Medicaid
by the Trump administration. Currently, there are limited federal requirements
prohibiting discrimination on the basis of sexual
End Discrimination Against Gay and orientation or gender identity by healthcare orga-
Bisexual Blood Donors nizations participating in Medicare and Medicaid.
Largely in response to the COVID-19 pandemic, the This lack of uniform federal protection damages
Department of Health and Human Services (HHS) the quality of care patients receive across the
amended the deferral on blood donation for gay country. The Centers for Medicare and Medicaid
and bisexual men from one year to three months. Services within the Department of Health and
This change, however, continues to effectively bar Human Services should publish final regulations
the vast majority of gay and bisexual men from incorporating explicit nondiscrimination protections
becoming blood donors irrespective of their risk for for LGBTQ people within the Conditions of Partic-
HIV. Neither the current nor pending policy treats ipation (CoPs) that healthcare organizations must
persons with like risks in a similar way. Rather, meet in order to begin and continue participating
donors are deferred based on their membership in in Medicare and Medicaid.
a group—in this case, all men who have sex with
men—rather than engagement in risky behavior, Create an Inclusive Federal
such as unprotected sex. HHS should adopt a policy Definition of Bullying
based in sound science that assesses all potential HRC’s Growing Up LGBT in America, a ground-
donors based on their engagement in risky behavior, breaking survey of more than 10,000 LGBTQ-iden-
not on sexual orientation. tified youth ages 13 to17, found that LGBTQ youth
are more than twice as likely as their straight and
End Discrimination Against Gay and Bisexual cisgender peers to experience verbal bullying in
Tissue and Cornea Donors school. Unfortunately, not all teachers or youth
The Department of Health and Human Services recognize bullying of LGBTQ youth as a problem.
(HHS) requires a deferral tissue and cornea dona- The Substance Abuse and Mental Health Services
tion for gay and bisexual men for five years. This Administration (SAMHSA) provides well-respect-
policy effectively bars the vast majority of gay and ed resources on the subject of bullying that reach
bisexual men from becoming tissue and cornea a wide audience. The Department of Health and
donors irrespective of their risk for HIV. Neither Human Services should direct SAMHSA to create a
the current nor pending policy treats persons federal definition of bullying that explicitly includes
with like risks in a similar way. Rather, donors are sexual orientation and gender identity.
deferred based on their membership in a group—in
this case, all men who have sex with men—rath- Ensure That Youth Shelters Are
er than engagement in risky behavior, such as Inclusive and Welcoming
unprotected sex. HHS should adopt a policy based LGBTQ youth are overrepresented among the
in sound science that assesses all potential donors homeless youth population with approximately 40
based on their engagement in risky behavior, not percent of homeless youth identifying as LGBTQ.
on sexual orientation. The Department of Health and Human Services
(HHS) Administration for Children and FamiliesHUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 11
should issue guidance to assist service providers fidentiality of these services when Medicaid sends
in understanding their obligations to LGBTQ youth explanations of benefits (EOBs) to their parents or
including ensuring that transgender youth have guardians. The Centers for Medicare and Medicaid
access to gender-specific clothing, programing, and Services (CMS) should bar state Medicaid programs
housing consistent with their gender identity. from issuing EOBs. EOBs are unnecessary for Med-
icaid since the recipient of services does not owe
Protect LGBTQ Foster Youth from the provider for care.
Discrimination in Foster Homes and
Out-of-Home Care Placements Prohibit Mental Health Professionals
LGBTQ youth are overrepresented in the foster in Federally Funded Foster Care
care system and are vulnerable to discrimination Institutions and Programs from Engaging
and mistreatment. The Department of Health and in Conversion Therapy or Referring
Human Services should issue guidance for foster Minors to Conversion Therapy
care systems and out-of-home care services to Currently, there are no federal regulations that
ensure the safety and well-being of LGBTQ youth, expressly prohibit mental health professionals in
as well as explicitly providing nondiscrimination federally funded foster care institutions or programs
protections. That guidance must ensure that from directly providing or referring minors to provid-
transgender youth have access to gender-specific ers of conversion therapy, which includes a range
clothing, programming, and housing consistent of harmful and discredited practices that seek to
with their gender identity. change a person’s sexual orientation or gender
identity. The Department of Health and Human
Ensure Confidentiality of Sensitive Health Services (HHS) should prescribe rules requiring any
Services for Dependents in Public and foster care institution or program that receives HHS
Private Health Insurance Plans funding to implement policies that prohibit mental
Young people who seek sensitive health services, health professional staff from engaging in or refer-
including HIV prevention or treatment or transi- ring minors to providers of conversion therapy.
tion-related care, have difficulty protecting the
confidentiality of these services when insurance Restore Conscience Protections
companies send explanations of benefits (EOBs) in Healthcare with Nondiscrimination
detailing these services to the primary policyhold- Safeguards
er, usually a parent or guardian. The Department In January 2018, the Department of Health and Hu-
of Health and Human Services should promulgate man Services (HHS) formally published a regulation
regulations to protect the confidentiality of young in coordination with the creation of a new division
people who are dependents from unwanted disclo- within the Office of Civil Rights tasked explicitly
sures by requiring insurance companies mail EOBs with enforcing federal conscience and religious
to the person receiving care. liberty laws. This new division and the accompa-
nying regulation raise serious concerns regarding
End Use of Explanation of Benefits (EOBs) access to critical care for some of the most vul-
for Medicaid to Ensure Confidentiality of nerable patients—including those who are LGBTQ.
Health Services for Dependents The rule purports to implement existing conscience
Young people who seek sensitive health services, regulations, but also provides sweeping exemptions
including HIV prevention or treatment and transi- for anyone working in a healthcare setting from pro-
tion-related care, have difficulty protecting the con- viding a range of medical services. It also reinstates12 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
the 2008 Bush HHS Conscience Rule that allowed to children in need of homes and families who will
refusal of medical care for any reason by doctors, care for them. The administration should restore the
nurses, medical technicians, and even receptionists. sexual orientation data collection and add gender
The administration should immediately rescind this identity data collection.
rule and evaluate the efficacy and impact of the
separate conscience division within the Office for Revoke Waiver to South Carolina
Civil Rights. In 2019, the Department of Health and Human
Services (HHS) granted a waiver from federal
Rescind and Replace Regulations nondiscrimination requirements to South Carolina’s
Restricting Coverage of Section 1557 Foster Care Program, which has contracted with a
of the Affordable Care Act child welfare provider who seeks permission to re-
The Department of Health and Human Services fuse to serve prospective parents who do not share
published revised implementing regulations for their religious beliefs, but who wants to continue to
Section 1557 of the Affordable Care Act (ACA). receive federal funding to provide those services.
These revisions remove all explicit protections in South Carolina requested the waiver to allow feder-
healthcare for LGBTQ people. More specifically, it al funds to go to a child welfare agency that refused
eliminates the explicit inclusion of discrimination on to place children with Jewish families. By granting
the basis of “gender identity” within the regulation’s that waiver, HHS opened the door to federally fund-
sex nondiscrimination protections. Section 1557 ed discrimination justified by religious belief against
and the original 2016 implementing regulations any number of prospective parents, including single
were a sea change for LGBTQ patients access- parents, LGBTQ individuals or same-sex couples,
ing healthcare services and insurance coverage. parents who may previously have been divorced,
The revisions are unnecessary, unwarranted, and interfaith couples, or people of deep faith that
undermine the public health. They also fail to reflect happens to be of another religion. The administra-
the incorporation of sexual orientation and gender tion should revoke this waiver immediately and take
identity within the scope of sex discrimination pro- steps to ensure that discrimination has no place in
tections as provided by Bostock. The administration federally funded foster care and adoption services.
should rescind this regulation and replace it with a
policy that explicitly includes sexual orientation and
gender identity within the definition of sex discrimi- DEPARTMENT OF HOMELAND
nation under the ACA. SECURITY
Restore Data Collection Requirements for Release Detainees and Ensure Humane
LGBTQ Youth in Foster Care Treatment for Transgender Detainees who
In 2020, the Department of Health and Human Ser- Cannot be Released
vices (HHS) published a final regulation abandoning The U.S. Immigration and Customs Enforcement
data collection on the sexual orientation of youth in (ICE), a division of the Department of Homeland
foster care as well as foster and adoptive parents Security, should release detainees who are not a
and guardians in the Adoption and Foster Care threat to the public. LGBTQ people are particularly
Analysis and Reporting System (AFCARS). The vulnerable to abuse when they enter institutional-
data from AFCARS provides states, the Children’s ized settings. In the rare instances in which a trans-
Bureau, and foster care and adoption providers with gender person poses a clear and imminent threat
valuable information to ensure safety and security to public saftey, ICE shoud establish and enforceHUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 13
clearer standards of humane treatment for trans- Ensure Equal Access to Federal
gender detainees including appropriate housing and Disaster Relief Benefits
prevention of sexual abuse and assault. Experiencing a disaster is traumatic and disruptive
for any individual; unfortunately for LGBTQ people,
Release Detainees and Provide Proper this negative experience is often compounded by
Medical Treatment for Transgender discrimination. Same-sex couples often face having
Detainees who Cannot be Released their families split apart because their relationships
The Department of Homeland Security (DHS) are not recognized by the relief workers, and trans-
does not consistently provide proper medical treat- gender people are too often denied access to safe,
ment to transgender inmates who wish to begin gender-appropriate facilities. The Federal Emer-
or to continue medical treatment in the course of gency Management Agency (FEMA) should issue
their gender transition process. DHS should direct guidance clarifying that LGBTQ people and their
U.S. Immigration and Customs Enforcement (ICE) families shall have equal access to federal funding
to release detainees who are not a threat to the and recovery support to which they are entitled.
public. In the rare instances in which a transgender In addition, the Department of Homeland Security
person poses a clear and imminent threat to public should update all nondiscrimination provisions per-
saftey, ICE should ensure that the transgender taining to disaster services to protect on the basis
detainee is allowed to begin, to continue, and to of sexual orientation and gender identity to reflect
progress with all necessary psychological and the decision in Bostock.
medical transition-related care.
Release Detainees and Ensure Appropriate DEPARTMENT OF HOUSING AND
Healthcare Standards for HIV-Positive URBAN DEVELOPMENT
Detainees who Cannot be Released
Current standards for the treatment of HIV-posi- Expand Outreach to Homeless
tive detainees established by the U.S. Immigration LGBTQ Veterans
and Customs Enforcement (ICE), a division of the Long-term discrimination by the federal govern-
Department of Homeland Security (DHS), fail to ment against LGBTQ servicemembers has left
provide adequate medical care to detainees with many LGBTQ veterans reluctant to seek the federal
HIV. Despite the vast assortment of policies and assistance they are entitled to. The Department of
standards, DHS guidelines are overly broad and Housing and Urban Development should expand
do not provide any direction for detention officials their homeless population outreach to be actively
on how to treat and care for detainees with HIV. inclusive of LGBTQ veterans.
DHS should direct ICE to release detainees who
are not a threat to the public. In the rare instances Outreach to LGBTQ Youth Centers to
in which an HIV-positive person poses a clear and Connect Youth to HUD Services
imminent threat to public safety, DHS should revise Through programs such as the Family Unifica-
standards to address counseling, consultation tion Program and the Youth Services Bureau,
and/or supervision of HIV-related clinicians with the Department of Housing and Urban Develop-
expertise in HIV care, and procedures to ensure ment (HUD) provides resources to youth who are
maintenance of confidentiality. In addition, DHS struggling with access to housing. LGBTQ youth
should ensure that all detainees receive HIV pre- are overrepresented in the foster care system
vention education. and among homeless youth. Serving as a critical14 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
resource, LGBTQ youth centers frequently have the cluding those who are LGBTQ. The administration
ability to direct LGBTQ youth to programs designed should restore the AFFH regulation immediately.
to meet many of the challenges they regularly face.
HUD should reach out to LGBTQ youth centers to Restore Disparate Impact Regulation
provide them with information regarding HUD ser- In 2020, the Department of Housing and Urban
vices for youth and to encourage them to connect Development (HUD) rescinded the 2013 Dispa-
the youth in their programs to HUD services. rate Effects Rule that implemented and formalized
the discriminatory effects standard and the bur-
Restore Inclusive Implementation den-shifting test used by HUD to determine liability
of the Equal Access Rule under the Fair Housing Act. Disparate impact
HUD has proposed revisions to the Equal Access claims under the Fair Housing Act are critical to
regulation—a landmark housing protection that addressing systemic housing discrimination and
prohibits discrimination in all HUD funded programs segregation in the United States. In practice, this
including rental assistance, emergency shelters, and regulation protected individuals from discrimination
FHA loan programs. Secretary Carson’s revisions emerging from facially neutral policies and practices
specifically target transgender people seeking crit- with disparate effects. The Disparate Effects Rule
ical emergency shelter. These revisions would allow protected individuals against particularly pernicious
shelters receiving taxpayer dollars to turn transgen- aspects of discrimination that may be overlooked
der people away entirely or provide unsafe housing. at first by nondiscrimination efforts due to the lack
The administration should rescind this proposal of—at least visible—discriminatory intent. Regard-
immediately and return to vigorous enforcement of less of intent, policies and practices with a disparate
this meaningful regulation. effect further limit housing access for historically
marginalized people, including LGBTQ individuals.
Restore Affirmatively Furthering This clear regulatory standard promoted consisten-
Fair Housing Regulation cy in enforcement of the Fair Housing Act which is
In 2020, the Department of Housing and Urban essential to both the public and property owners
Development withdrew the 2015 Affirmatively Fur- seeking to comply with the law. The administration
thering Fair Housing (AFFH) rule implementing a should reinstate this standard.
section of the Fair Housing Act that directs juris-
dictions accepting federal funds to take significant
actions to promote equality and to “affirmatively DEPARTMENT OF JUSTICE
further fair housing.” This 2015 rule required com-
munities to conduct an “Assessment of Fair Hous- Prohibit Mental Health Professionals
ing” to scrutinize their current patterns of integration in Federally Funded Juvenile Justice
and segregation, evaluate areas of poverty, and Institutions and Programs from Engaging
identify disparities in equal access and dispropor- in Conversion Therapy or Referring
tionate housing. Once that assessment is complete, Minors to Conversion Therapy
the community must set goals to improve their Currently, there are no federal regulations that
housing patterns. By identifying continued housing expressly prohibit mental health professionals in
inequality, these AFFH provisions were a critical federally funded juvenile justice institutions and
step towards ensuring that everyone has access to programs from directly providing or referring minors
homes in communities that provide opportunities to providers of conversion therapy, which includes
and resources for themselves and their families—in- a range of harmful and discredited practices thatHUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 15
seek to change a person’s sexual orientation or transmission is several times higher in prison than
gender identity. The Department of Justice (DOJ) in the general population. The best way to ensure
should prescribe rules requiring any juvenile justice that prisons do not become a prime environment
institution or program that receives DOJ funding to for transmission is appropriate education and
implement policies that prohibit mental health pro- prevention. The Bureau of Prisons (BOP) should
fessional staff from engaging in or referring minors issue guidelines for comprehensive HIV prevention
to providers of conversion therapy. in BOP facilities, which should include educa-
tion about HIV transmission and information and
Ensure Incarcerated Transgender access to PrEP and other proven HIV and STI
Individuals are Housed Safely prevention tools.
The Federal Bureau of Prisons has rolled back a
policy that allowed incarcerated transgender people Ensure Implementation of the Matthew
to be housed consistent with their gender identity. Shepard and James Byrd, Jr. Hate Crime
With transgender people experiencing sexual as- Prevention Act and Appropriate Collections
sault at dramatically higher rates than average, this of Statistics
decision only puts them at further risk of assault. Hate crimes affect not only the victims and their
The Attorney General should direct the Bureau of families, but generate fear and insecurity for the
Prisons to take steps to ensure that incarcerated entire community they target. The Federal Bureau
transgender people are housed safely and in accor- of Investigation’s (FBI) 2018 Hate Crimes Statis-
dance with their gender identity. tics report indicated that nearly one in five of all
hate crimes reported to the FBI were motivated
Provide Proper Medical Treatment by anti-LGBTQ bias, an overall increase from the
for Transgender Individuals in Federal year prior. The incidence of anti-transgender crimes
Prison Facilities increased by 34 percent since 2017. Because this
The Bureau of Prisons (BOP) denies proper med- voluntary data is far from complete, the Department
ical treatment to incarcerated transgender people of Justice (DOJ) should intensify efforts to encour-
who wish to begin or to continue medical treatment age local law enforcement to report hate crimes
in the course of their gender transition process by statistics annually. In addition, DOJ should expand
prohibiting them from initiating any new treatment. educational and training initiatives to address dis-
BOP should direct the Office of National Policy crimination in communities and expand the con-
Review to issue a Change Notice to the Program vening of hate crimes forums across the country to
Statement regarding Patient Care to ensure that engage community leaders and citizens in ways to
transition-related care is considered medically effectively prevent and respond to hate crimes.
necessary care, and that all incarcerated transgen-
der people are allowed to begin, to continue, and Rescind the 2007 Office of Legal
to progress with psychological and medical transi- Counsel Memo Allowing Discrimination
tion-related care. Against Beneficiaries by Religiously
Affiliated Grantees
Provide Access to Comprehensive HIV In a 2007 memo, the Office of Legal Counsel (OLC)
Prevention in Federal Prison Facilities at the Department of Justice (DOJ) stated that a
Rates of transmission for HIV in prisons remain religiously affiliated employer could discriminate
a consistent concern for the LGBTQ community. against employees on the basis of religion under the
The Bureau of Justice Statistics found that HIV protections of the Religious Freedom Restoration16 HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE
Act (RFRA). This opinion is far reaching and has violence, raising the age in respondents from 16
opened the door to more expansive discrimination to 18. Respondents voluntarily and confidentially
under the guise of religious liberty since its publica- give information about their sexual orientation and
tion more than a decade ago. DOJ should rescind gender identity as part of the National Crime Vic-
this opinion and any subsequent guidance applying timization Survey (NCVS). The increase in minimum
the opinion to specific federal programs. age for respondents to 18 will result in the loss of
critical data on the prevalence of violence, bullying,
Address LGBTQ Policing Challenges in and harassment experienced by LGBTQ youth. The
Investigations and Consent Decrees administration should return to collecting more com-
During the Obama administration, the Civil Rights plete data on this population.
Division of the Department of Justice (DOJ) had
addressed LGBTQ policing challenges in investiga- Ensure Uniform and Full Implementation
tions and consent decrees. DOJ investigations have of Bostock v. Clayton County Across
found police departments to engage in patterns Federal Agencies
and practices of unconstitutional discrimination In the consolidated cases Bostock v. Clayton Coun-
against members of the community, including LGBTQ ty, Altitude Express v. Zarda and R.G. & G.R. Harris
community members. Consent decrees are court-ap- Funeral Homes v. EEOC, the Supreme Court held
proved agreements between DOJ and the police that Title VII of the Civil Rights Act of 1964 prohib-
department under investigation. One goal of most its discrimination on the basis of sexual orientation,
consent decrees is “bias-free policing” provisions, gender identity, and transgender status as unlawful
which call for creating a policy to guide officers’ inter- sex discrimination. The Attorney General should be-
actions with LGBTQ residents. DOJ should actively gin coordinating full implementation of this decision,
re-engage with local LGBTQ communities and police including by publishing guidance confirming that
departments to ensure these goals are achieved. discrimination on the basis of sexual orientation,
gender identity, and transgender status is unlawful
Prohibit Discrimination in Jury Selection sex discrimination under all federal statutory and
The right to an impartial jury of one’s peers and regulatory provisions.
the right to serve on a jury are foundational to the
fairness that Americans expect and deserve from
our legal system. The LGBTQ community has a DEPARTMENT OF LABOR
history of discrimination when being considered for
jury service, and routine exclusion of LGBTQ people Ensure Treatments Relating to Gender
often results in a miscarriage of justice. The De- Transition Qualify for FMLA Leave
partment of Justice should issue guidance clarifying The lack of guidance from the Department of
that the Jury Service and Selection Act prohibition Labor (DOL) in defining “serious medical condi-
on exclusion from jury service based on sex in- tions” under the Family and Medical Leave Act
cludes a prohibition on exclusion based on sexual (FMLA) may result in the unfair denial of leave
orientation and gender identity. under FMLA for transgender individuals undergo-
ing medical or psychological treatments associ-
Restore Collection of Data on LGBTQ ated with gender transition. DOL should issue an
Youth Impacted by Violence official ruling stating that medical or psychological
In 2018, the Department of Justice restricted data treatments associated with gender dysphoria are
collection on LGBTQ youth who are subjected to not “cosmetic” procedures under FMLA regula-HUMAN RIGHTS CAMPAIGN • 2020 BLUEPRINT FOR POSITIVE CHANGE 17
tions and that hormone therapy as part of gender abilities is unnecessary and inconsequential. It sets a
transition constitutes a “regimen of continued precedent for future carve-outs and represents the
treatment.” Furthermore, DOL should provide Trump administration’s consistent abandonment of
guidance for leave for mental health conditions equal opportunity. This is a stark reversal of OFCCP
under FMLA, including an example of an individual policy and legal arguments for the past decade. It
who would qualify for leave for psychotherapy for also exceeds the Congressional carve out created by
gender dysphoria and for all subsequent medical Section 715 of the National Defense Authorization
and psychological treatment. Act. The administration should rescind this proposal.
Restore Nondiscrimination Standards Eliminate Discrimination Against
for Government Contractors LGBTQ Beneficiaries by Department
The Department of Labor published a proposed rule of Labor Grantees
incorporating an expansive religious exemption for Federal grantees operate as an extension of the
businesses and organizations contracting with the federal government by utilizing taxpayer funds.
federal government that are covered under Execu- Nondiscrimination provisions are crucial to en-
tive Order 11,246—which explicitly prohibits discrim- suring equal access to federally funded services.
ination on the basis of race, creed, color, religion, The Department of Labor (DOL) provides grants
sex, national origin, sexual orientation, and gender to programs in areas such as occupational safety
identity. Under the proposed regulation, businesses training and assisting workers affected by mass
and organizations receiving taxpayer dollars could layoffs, plant closures, and disasters. DOL should
present religious belief as a defense to a claim of implement rules and provide guidance to ensure
employment discrimination to Office of Federal that discrimination against LGBTQ beneficiaries is
Contract Compliance Programs (OFCCP), which will prohibited by recipients of DOL grants.
then not enforce the nondiscrimination provisions.
The administration should rescind this proposal and Revise Religious Exemption Reporting
ensure that taxpayer dollars are not used to facili- Process for Grantees
tate discrimination. The Department of Labor (DOL) has an estab-
lished process for providing exemptions from the
Restore Civil Rights Obligations of religious nondiscrimination provision in the Work-
TRICARE Providers Under OFCCP place Investment Act for faith-based organizations.
The Department of Labor published a proposed rule In order to ensure that the exemption is not used
removing Office of Federal Contract Compliance to permit broader discrimination based on a recipi-
Programs (OFCCP) authority to enforce nondiscrim- ent’s religious tenets, DOL should clarify the scope
ination and affirmative action requirements under of this exemption through informal guidance to
numerous statues including the Vietnam Era Veter- program administrators. DOL should also create an
ans’ Readjustment Assistance Act, the Rehabilitation additional reporting requirement for organizations
Act of 1973, and EO 11246 for TRICARE providers. that receive the exemption.
The exclusion of TRICARE providers from the em-
ployment discrimination rules applicable to federal Include LGBTQ Questions on Current
contractors not only has a detrimental impact on the Population Survey
workforces affected, but sends a disturbing message Currently, there are no questions regarding sexual
that ensuring fair treatment for women, people of orientation or gender identity in the demograph-
color, LGBTQ people, veterans, and people with dis- ics section of the United States Census BureauYou can also read
