For the first time, a federal court has confirmed that the Affordable Care Act (ACA) prohibits discrimination against transgender people by any health care provider accepting federal funds. In the case of a young transgender man who says he was badly mistreated in a Minnesota hospital, the court ruled Monday that Section 1557 of the ACA prohibits gender identity discrimination under the umbrella of sex discrimination, and that by accepting Medicare and Medicaid funds the hospital was subject to the law.

In the lawsuit, the young man states that he went to the emergency room last year with his mother—herself a medical professional—with painful genitourinary symptoms. While in the hospital for six days, he says he was repeatedly misgendered, ridiculed, given careless and assaultive exams, and otherwise provided untimely and inferior care because he is transgender. The US Department of Health and Human Services (HHS) is still separately investigating the case. The hospital and the group that employs its ER physicians urged the court to dismiss the suit, saying they were not covered by the law, that it didn’t prohibit anti-trans bias, and that the patient’s complaints were nothing more than “perceived slights” rather than serious discrimination. The court rejected all these contentions, saying the suit, brought by Minnesota-based advocacy group Gender Justice and captioned Rumble v. Fairview Health Services, could go forward.

Though the ACA’s civil rights provision has been effective since 2010, few cases have been brought to court or to HHS’s civil rights office. In the absence of formal implementing rules from HHS, this part of the law remains little-known, even among LGBT patients who may benefit greatly from its protections. NCTE Policy Director Harper Jean Tobin said, "This case illustrates the need for transgender people to stand up for their rights in health care settings. Having recently experienced a stay in a hospital myself, I know that no matter who you are, if you are trans the fear of mistreatment in medical settings is constant. When it happens, trans people need to know that, no matter where you live, there's something you can do."

Nearly 1 in 5 trans people have been refused care, more than 1 in 4 have been harassed, and just as many have avoided seeking care when sick or injured out of fear of discrimination, according to the National Transgender Discrimination Survey​. While many hospitals and other providers are embracing equality and best practices, many if not most trans people still live with very real and reasonable fears when seeking care.

If you have been mistreated when seeking care because of your gender—including being transgender or gender nonconforming—visit NCTE’s Know Your Rights resource to find out what you can do and where to get help.​