Can a Doctor Refuse to Treat You for Being LGBTQ? — Your Rights Under ACA Section 1557

No, a doctor cannot refuse to treat you based on your sexual orientation, gender identity, or sex — including pregnancy — if the health care provider receives any federal funding. Section 1557 of the Affordable Care Act (ACA) prohibits sex discrimination in health care, and that includes discrimination based on sexual orientation, gender identity, and sex stereotypes.

This protection covers the majority of health care providers in the United States: hospitals, clinics, medical practices, and health insurance plans that accept Medicare, Medicaid, or any other federal financial assistance from the Department of Health and Human Services (HHS). Private-pay-only practices that take no federal funds may not be covered, but these are the exception, not the rule.

This guide explains what the law protects, what counts as discrimination, when a religious objection might apply, and exactly how to file a complaint if a provider refuses you care.

What Is Section 1557 of the Affordable Care Act?

Section 1557 is the health care nondiscrimination provision of the ACA, codified at 42 U.S.C. § 18116. It was the first federal civil rights law to specifically prohibit sex discrimination in health care programs receiving federal funding.

Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in:

• Any health program or activity that receives federal financial assistance from HHS (this includes Medicare Part A and B providers, Medicaid providers, CHIP, and many other federal health programs)
• Any health program administered by HHS itself
• The Health Insurance Marketplaces and plans offered through them

Source: 42 U.S.C. § 18116; 45 C.F.R. § 92.101 (2024 rule).

What "Sex" Discrimination Means After Bostock and the 2024 Rule

In Bostock v. Clayton County, 590 U.S. 644 (2020), the Supreme Court held that discrimination "because of sex" under Title VII of the Civil Rights Act of 1964 necessarily includes discrimination based on sexual orientation and gender identity. Following Bostock, HHS issued a final rule in 2024 (effective July 5, 2024) that codified the same interpretation for Section 1557: discrimination on the basis of sex includes discrimination based on:

• Sexual orientation
• Gender identity
• Sex stereotypes
• Pregnancy, childbirth, or related medical conditions
• Termination of pregnancy

Source: 89 Fed. Reg. 37522 (May 6, 2024); 45 C.F.R. § 92.101(a)(2).

The 2024 rule restored protections that had been vacated by a federal court during the Trump administration. The rule explicitly states that a covered entity "shall not" discriminate on the basis of sex in any health program or activity.

What Counts as Discrimination in Health Care

Discrimination under Section 1557 includes:

• Outright denial of care: A doctor or hospital refusing to treat you because of your sexual orientation or gender identity
• Different treatment: Providing inferior care, shorter appointments, or less thorough examinations compared to other patients
• Segregation: Placing LGBTQ patients in different treatment areas or scheduling them at different times
• Harassment: Staff making degrading comments, misgendering a patient, or creating a hostile care environment
• Failure to accommodate: Not using a patient's chosen name and pronouns, refusing to provide appropriate gender-affirming care, or refusing to allow a same-sex partner to be present

Examples of likely violations:

• A hospital emergency room refuses to treat a transgender patient for a non-gender-related condition (e.g., a broken arm) because the patient is transgender
• A clinic cancels a patient's appointment after learning the patient is in a same-sex relationship
• A doctor refuses to perform a routine Pap smear on a lesbian patient, saying she "doesn't need it"
• A medical practice posts a policy stating it will not treat "LGBTQ patients"

When Can a Provider Refuse Care Based on Religious Objections?

This is the most common area of confusion. Several federal laws allow health care providers to refuse to participate in specific procedures based on religious or moral objections:

• The Church Amendments (42 U.S.C. § 300a-7) — allow refusal to perform abortion or sterilization procedures
• The Weldon Amendment (annual appropriations rider) — prohibits federal funding discrimination against providers that refuse to participate in abortion
• The Conscience Provisions (42 U.S.C. § 238n) — allow refusal to provide services that violate religious or moral beliefs

Critical distinction: These laws protect the right to refuse to perform a specific procedure (e.g., abortion, sterilization). They do not give a provider the right to refuse all medical care to a patient because of the patient's sexual orientation or gender identity.

A doctor who says "I don't treat LGBTQ patients" and refuses to provide a flu shot, a blood pressure check, or diabetes management is not invoking a procedure-specific religious objection. That is a flat refusal to care for a class of patients, which Section 1557 prohibits.

Source: HHS OCR Fact Sheet: "Protecting Conscience and Religious Freedom in Health Care" (hhs.gov); Bostock v. Clayton County, 590 U.S. 644 (2020) (discrimination against a person because of their sexual orientation or gender identity is discrimination because of sex).

What About State Laws?

Some states have passed laws that explicitly protect LGBTQ access to health care:

• California: The Lanterman-Petris-Short Act and state civil rights law prohibit discrimination based on sexual orientation and gender identity in health care (Cal. Civ. Code § 51; Cal. Health & Safety Code § 1365.5)
• New York: Sexual orientation and gender identity are protected classes under the New York State Human Rights Law (N.Y. Exec. Law § 296)
• Illinois: The Illinois Human Rights Act prohibits discrimination in health care based on sexual orientation and gender identity
• Massachusetts: M.G.L. c. 272, § 92A prohibits discrimination in public accommodations, including health care facilities

At the same time, some states have passed laws or implemented policies that limit access to gender-affirming care for minors. These state-level restrictions do not directly affect the federal protections Section 1557 provides, but they create a complex legal landscape. If you are denied care, consult an attorney familiar with your state's law.

Source: Movement Advancement Project, "Healthcare Laws and Policies" (mapresearch.org, accessed September 2026); HHS OCR Section 1557 enforcement data.

What to Do If a Doctor Refuses to Treat You

Step 1: Document Everything

• Write down the exact words used — what the provider said and who said it
• Note the date, time, and location
• Get the names of any witnesses (other patients, staff who overheard)
• Save any written communications — emails, text messages, the provider's posted policies
• Obtain your medical records (you have a legal right to them under HIPAA)

Step 2: File a Complaint with HHS OCR

Deadline: 180 days from the date of discrimination.

How to file:

• Online: hhs.gov/ocr/complaints
• By phone: 1-800-368-1019 (TDD: 1-800-537-7697)
• By mail: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Bldg., Washington, DC 20201

What OCR needs:

• Your name, address, and contact information
• The provider's name and address
• A clear description of what happened and why you believe it was discrimination
• The date(s) of the discriminatory act
• Your signature (electronic or physical)

The process is free. You do not need a lawyer. OCR provides language assistance and disability accommodations.

What happens after you file: OCR investigates. If it finds a violation, it will try to negotiate a voluntary resolution (corrective action, policy changes, training) with the provider. If no resolution is reached, OCR may refer the case to the Department of Justice for enforcement or terminate federal funding to the provider.

Source: 45 C.F.R. § 92.301 (OCR complaint procedures); hhs.gov/ocr/complaints.

Step 3: Consider a Private Lawsuit

Section 1557 does not explicitly say whether individuals have a private right of action (the right to sue in federal court directly). Federal courts have been split on this question. The 2024 rule states that it does not create a private right of action, but some courts have held that one exists by implication, especially since Section 1557 incorporates Title VI, Title IX, the Age Discrimination Act, and Section 504 of the Rehabilitation Act — all of which have private rights of action.

If you have a strong case, consult a civil rights attorney. The ACLU, Lambda Legal, and the National Center for Lesbian Rights (NCLR) all take healthcare discrimination cases.

Step 4: Also File a Complaint with the State

Many states have their own civil rights agencies that investigate healthcare discrimination. Filing with the state preserves your rights under state law and may result in a faster resolution.

Key Deadlines

Action	Deadline
File HHS OCR complaint	180 days from the discrimination
File state law complaint	Varies by state (typically 1-3 years)
Section 1983 lawsuit (if constitutional claim)	Varies by state (typically 2-3 years)

What Damages Can You Recover?

If you win a Section 1557 claim or a related Section 1983 claim, you may recover:

• Compensatory damages for emotional distress, pain and suffering, and medical expenses
• Injunctive relief — a court order requiring the provider to change its policies
• Attorney's fees — if you prevail, the provider pays your legal fees (42 U.S.C. § 1988 for Section 1983 claims; similarly available under Title VI enforcement)
• Punitive damages — may be available against individual defendants in some circumstances

Where to Get Help

• HHS OCR: hhs.gov/ocr — file a complaint, get information about your rights
• Lambda Legal: lambdalegal.org — LGBTQ legal advocacy, free helpline
• ACLU: aclu.org — civil rights litigation, including health care discrimination
• National Center for Transgender Equality: transequality.org — resources on health care access
• National LGBTQIA+ Health Education Center: lgbtqiahealtheducation.org — provider training and patient resources

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This article provides general legal information, not legal advice. Laws vary by state and individual circumstances differ. Section 1557 protections have been the subject of ongoing litigation, and the scope of coverage may change. Consult a licensed attorney for advice about your specific situation.