By Michael B. Garrett, MS, CCM, CVE
The month of June is Pride Month for the LGBTQ+ community. It was selected due to the riots that took place in late June 1969 at the Stonewall Inn in New York City, which was a queer bar operated by the mafia. The police raided the bar, which was a common occurrence in the 20th century in the United States, and the patrons of the bar and others chose to fight back. This was not the first instance of LGBTQ+ resistance, but it was significant in that it lasted several days and gained widespread support. As a result, Pride parades and events started the following year. However, it should be clear that the Stonewall incident was a riot and a protest, even though today’s Pride events tend to be celebratory. It should
The LGBTQ+ community is in an ongoing struggle for equality from a variety of perspectives, such as marriage, employment opportunities, and healthcare. As a gay man with family members and friends who are a part of the LGBTQ+ community, I have had firsthand witness to struggles with accessing inclusive and culturally competent care as well as other barriers to full inclusion. This has included appealing a denial of a pap smear for a transgender man to obtain coverage by the health plan. This has involved navigating both insurance and healthcare systems to access necessary and culturally competent healthcare services that meet the requirements for coverage from the health plan.
For the last ten years, I have been involved in advocating for necessary gender-affirming care for transgender and gender-diverse individuals. This has included communicating with health plans and revising their clinical coverage policies to incorporate comprehensive, evidence-based gender-affirming care. I have also focused on improving access to health and benefits that significantly impact the broader LGBTQ+ community. This has included issues such as not covering so-called “conversion therapy” as well as reporting providers to licensing agencies who engage in this debunked and harmful practice. It has also included advocating for the removal of barriers to accessing pre-exposure prophylaxis (PrEP), which is a medication that reduces the risk of transmitting HIV.
Here are some actions that professional case managers can take to become more inclusive of the LGBTQ+ community and the clients that are served:
Use the name, gender identity, and pronouns the client uses: Regardless of what your system has listed, the client gets to use whatever name, gender identity, and pronouns that they want. This may be challenging for some, but to gain the trust of the client, the professional case manager needs to honor however the client identifies.
Respect the client’s choice of family members and caregivers: The client may identify a “family of choice” rather than the “family of origin” as their family. Many LGBTQ+ individuals have been rejected by their family of origin, or there may have been significant conflicts with them. The LGBTQ+ client may identify a family of choice that includes individuals who are not related by blood but who are; nevertheless, the client has gathered to surround them with support. The client also has the opportunity to select their chosen caregivers.
Assist in making referrals to LGBTQ+ inclusive providers and services: The LGBTQ+ client may want to see a provider with whom they share the same sexual orientation, gender identity, or other characteristics. Several resources are available to identify LGBTQ+ affirming providers, including GLMA: Health Professionals Advancing LGBTQ+ Equality, OutCare, and FOLX Health, among others. Some of these are free, and others require a fee. If and when the professional case manager uses a directory like this, they should also make sure to cross-reference the client’s benefit plan to determine if the provider is considered in-network to optimize benefit coverage.
Facilitate access to necessary preventive services: LGBTQ+ clients may likely have had negative encounters with healthcare providers and facilities, including offensive statements, condemnation of their choice of partner/spouse, and even physical abuse. As a result, some LGBTQ+ individuals avoid preventive services, which results in the late detection of severe conditions. Coordinating care to LGBTQ+ inclusive providers may help in facilitating access to necessary preventive services, such as cancer screenings. Another issue that can occur is that health insurance plans may have “gender-based claims edits,” such as a transgender male client who receives a pap smear or mammography having their claim denied because a claim system is programmed to deny services that are typically accessed by members who are listed as females. The professional case manager may want to assist the transgender client in appealing those kinds of denials for necessary preventive services.
Encourage adherence to chronic care guidelines: For the LGBTQ+ client with a chronic condition, it is critical for adherence to care guidelines, such as medications, follow up visits, monitoring certain signs and symptoms, etc. However, the LGBTQ+ client may not adhere for a variety of reasons, such as negative experiences with providers, financial impact due to high deductibles, or time constraints. The professional case manager can work with the client to identify barriers so there can be intervention strategies to address those barriers.
Engage in lifelong learning and development about LGBTQ+ issues: In order to be an effective professional case manager with LGBTQ+ individuals, it would be beneficial to engage in a continuous process of learning and development. The leaders of a case management organization can incorporate training events throughout the year, so professional case managers can better understand the needs and issues impacting LGBTQ+ individuals as well as learn about LGBTQ+ resources and services in the community.
Familiarize yourself with relevant clinical guidelines impacting LGBTQ+ clients: There are services that particularly impact the LGBTQ+ community. Gender affirming care is one significant area, and lately there has been legislative actions and other initiatives that have made it challenging for transgender and gender diverse clients to receive these services. The professional case manager can improve their impact by accessing clinical guidelines and clinical coverage policies from the client’s health plan. Additionally, the professional case manager may need to consult with specialists in gender-affirming care to optimize the advocacy work that is needed in these instances.
Professional case managers are expected to provide high-quality services for all the clients they serve, regardless of their identities or demographics. For the LGBTQ+ community and individuals who have been historically marginalized by the healthcare system, this will require education, advocacy, and cultural competence in order to optimize the effectiveness of professional case management services.
Join us in Dallas, TX, June 24-27, 2025, as we celebrate 35 years of case management excellence and innovation at the premier CM education and networking event of the year, the 2025 CMSA Annual Conference & Expo. https://cmsa.org/conference/
References and Resources
Stonewall Riots: United States History; https://www.britannica.com/event/Stonewall-riots Accessed 5/13/2023
Preventing HIV with PrEP; Centers for Disease Control and Prevention (CDC); https://www.cdc.gov/hiv/prevention/prep.html Accessed 5/13/2025
LGBTQ+ Healthcare Directory; GLMA: Health Professional Advancing LGBTQ+ Equality; https://www.glma.org/find_a_provider.php Accessed 5/13/2025
The OutList LGBTQ+ Affirming Healthcare Directory; OutCare; https://www.outcarehealth.org/outlist/ Accessed 5/13/2025
FOLX Health Clinicians; https://www.folxhealth.com/clinicians Accessed 5/13/2025
Discrimination and barriers to well-being: The state of the LGBTQI+ community in 2022; Center for American Progress (CAP); https://www.americanprogress.org/article/discrimination-and-barriers-to-well-being-the-state-of-the-lgbtqi-community-in-2022/ Accessed 5/13/2025
Bass, B., Nagy, H. Cultural competence in the care of LGBTQ patients. (Updated 2023 Nov 13). StatePearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563176/ Accessed 5/13/2025
Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents; American Academy of Pediatrics (AAP); https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for?autologincheck=redirected Accessed 5/13/2025
Standards of Care Version 8; World Professional Association for Transgender Health (WPATH); https://wpath.org/publications/soc8/ Accessed 5/13/2025
Glossary of Terms, Human Rights Campaign (HRC); https://www.hrc.org/resources/glossary-of-terms Accessed 5/13/2025
Bio: Michael Garrett possesses more than 30 years of progressively responsible experience in managed care, care/case management, utilization management and review, chronic condition management, health information technology, healthcare quality, and population health management services. He has served in operational management, business development, product development, and strategic planning roles. His experience includes developing and implementing new care delivery models, such as patient centered medical homes and accountable care organizations (ACOs). Michael has experience working in a range of benefit programs, including fully insured medical plans, self-funded health plans, workers compensation, Medicaid, government employee plans, and long term disability. He served as the leader in the successful development, implementation, and on-going maintenance of quality management programs for care management programs He has also worked with health plans and healthcare providers in evaluating, improving, and optimizing health information technology and healthcare quality programs. His commitment to the healthcare industry is demonstrated by leadership roles in key organizations, including serving as a member and chair on the Commission for Case Manager Certification, a committee member and chair of URACs clinical accreditation committee, and a member of the Case Management Society of America's Task Force for the Revision of the Standards of Practice for Case Management. He has served as an author, editor, and contributor on six case/care management books as well as the author of numerous journal articles in the field of care/case management. Michael's professional credentials include a Master of Science degree from the University of Idaho in clinical psychology and a Bachelor of Arts degree in psychology and religious studies from Gonzaga University. He is also a Certified Case Manager, Certified Vocational Evaluator, Nationally Certified Psychologist, and a Board Certified Patient Advocate.