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Rhode Island Leads on HIV Prevention with Game-Changing PrEP Access Law

By Joseph Metmowlee Garland, MD AAHVS, GLAD Board Vice President

As a doctor who has spent 18 years caring for people living with and vulnerable to HIV, one of the most frustrating and heartbreaking aspects of my work is knowing that despite the availability of drugs to prevent HIV infection, many people continue to contract HIV because they cannot access these medications.

In June the Rhode Island legislature passed, and Governor McKee signed, a law that will mean fewer people will get HIV.

While we have made great strides toward ensuring access to HIV treatment across the U.S., the availability of preventive medications has greatly lagged behind. PreExposure Prophylaxis (PrEP) — medications that prevent HIV transmission with nearly 100% effectiveness when

Joe Metmowlee Garland headshot
Joseph Metmowlee Garland

taken correctly — has been around for over a decade, yet access is not assured for many people. And it is the most vulnerable among us — people living in poverty or experiencing homelessness, those with substance use disorder, and racial and sexual minorities — who most often encounter barriers to receiving this medication that can protect them from a profoundly life-altering diagnosis.

Wonderfully, in June the Rhode Island legislature passed, and Governor McKee signed, a law that will mean fewer people will get HIV. “An Act Relating To Insurance – Accident And Sickness Insurance Policies – Insurance Coverage For Prevention Of HIV Infection” (S.2255/H.7625) will ensure Rhode Islanders who can benefit from PrEP will have easier and more timely access to the form of PrEP that works best for them.

This new law prohibits health insurance companies from requiring patients to make co-pays or meet a deductible in order to receive PrEP — including long-acting injectable PrEP — or any HIV prevention drug, practices known as cost sharing. Cost sharing can essentially make medications inaccessible to patients because of high co-pays or the need to meet a high deductible.

Importantly, the new law also bars prior authorization and step therapy for current and future injectable forms of PrEP. Prior authorization is an insurance practice that requires patients to wait for prior approval from their insurer in order to receive a specific medication. Step therapy is a practice in which insurers require patients to try alternative medications before they can receive the medicine their health care provider actually prescribed for them.

[This law] reflects a valuable lesson we have learned time and again in the fight against HIV: the more varied options we can offer people to access prevention and treatment methods, the more people will get the prevention services and treatment they need. People need options that fit with their lives.

Both of these processes create barriers for patients and health care providers.

Prior authorization requires the clinician to complete and submit additional paperwork to the insurer to justify the prescription – these additional forms are separate to the medical record and ask questions about the clinical indication, what alternatives have been tried, and often many other details. They are often time-consuming and can be frankly just confusing. Only after receiving the completed form will the insurer then determine whether they will cover the medication.

Step therapy can be similarly onerous – insurers can require the patient to try and “fail” a different medication (usually a cheaper option) before they would approve the prescribed medication. The reason for failure – side effects, ineffectiveness, etc. – will then need to be documented and submitted as part of a prior authorization to get approval of the originally-prescribed medication.

Both of these processes can be time-consuming and frustrating for clinicians and patients, and can effectively discourage both the provider and the patient from getting the medication. In a study by the American Medical Association on prior authorization practices, 91% of physicians reported that such requirements negatively impacted clinical outcomes for their patients. Another study found that prior authorization requirements exacerbated medical nonadherence, resulting in patients abandoning prescriptions almost 40% of the time. And the average physician completes 43 prior authorizations and spends 12 hours filling out these forms every week.

In my role as the Medical Director of the Infectious Diseases and Immunology Center at The Miriam Hospital, I have seen firsthand how cost sharing and prior authorization function as barriers to patients accessing PrEP and the form of the drug that is best for them.

In order to meet insurer prior authorization requirements for HIV and PrEP medications for patients at our clinic, we had to hire two additional staff members to handle the workload. Smaller clinics that don’t have the support of a larger health system obviously have a much harder time securing prior authorization for their patients, and often those patients just stop trying to get it. In fact, according to the CDC, in 2023 just 35% of people in Rhode Island for whom PrEP was indicated to prevent HIV were taking it. And while prior authorization and step therapy are not the only reasons for this access issue, they play a large role.

One critical aspect of S.2255/H.7625 is that it ensures that different forms of HIV prevention drugs be accessible to those who need them. This provision reflects a valuable lesson we have learned time and again in the fight against HIV: the more varied options we can offer people to access prevention and treatment methods, the more people will get the prevention services and treatment they need. People need options that fit with their lives.

Just think about it and you can imagine many scenarios where an injectable therapy would be the right option for a patient — people who have difficulty swallowing pills, people who can’t tolerate side effects to oral PrEP, people living in group or roommate settings with concerns about privacy around their medication, people who struggle to remember to take daily medications, and people who are unstably housed making medication adherence much harder. 

This concept is particularly important as injectable forms of PrEP become more widely available, including one anticipated medication that appears to prevent HIV transmission for up to six months per dose. Multiple studies have demonstrated that long-acting injectable medication are as effective at preventing HIV transmission as a daily oral PrEP medication, and often superior because of better adherence in people who can’t adhere to a daily pill regimen.

PrEP (Pre-Exposure Prophylaxis) bottle

Yet as of March 2024, just 35 patients in Rhode Island were getting injectable PrEP, largely because of prohibitive insurer restrictions. But thanks to S.2255/H.7625, this powerful form of prevention will now be more immediately accessible to many for whom PrEP was previously unfeasible.

Just think about it and you can imagine many scenarios where an injectable therapy would be the right option for a patient — people who have difficulty swallowing pills, people who can’t tolerate side effects to oral PrEP, people living in group or roommate settings with concerns about privacy around their medication, people who struggle to remember to take daily medications, and people who are unstably housed making medication adherence much harder. And many others – the point is, patients and their health care providers should be able to decide what prevention option works best for them.

The HIV prevention medications we have today are amazing scientific advances. But they’re no good if they cannot be accessed by the people who need them, when they need them. Rhode Island is the first state in the nation to enact comprehensive bans on prior authorization for current and soon-to-be-developed long-acting injectable PrEP medications, and hopefully many more states will follow.

S.2255/H.7625 is groundbreaking and incredibly meaningful to our community and it will completely change the landscape of PrEP access in the state. With this law, Rhode Island is demonstrating its commitment to compassionate, high-quality, evidence-based care, and to ensuring that we make every possible tool available to those who need them in the fight against HIV.

Learn more about GLAD’s work to expand access to PrEP.

News

Rhode Island Passes Bill to Safeguard Access to Essential Care

Health Care Provider Shield Act limits risk of hostile out-of-state laws banning abortion, transgender health care

June 13, 2024 (PROVIDENCE) – Health care providers and advocates for health care access, reproductive health, and LGBTQ+ equality praised the RI Legislature’s final passage today of the “Health Care Provider Shield Act,” (S2262 Sub B, HB757 Sub A), which will protect the state’s health care system, doctors, other medical care providers, and patients from hostile out-of-state laws that could negatively impact delivery of care. The bill now awaits action by Gov. Dan McKee. 

Sponsored by Senator Dawn Euer and Representative John G. Edwards, the Health Care Provider Shield Act will mitigate the risk that  Rhode Island health care providers could be penalized under the laws of other states that have banned access to established, standard-of-care reproductive and transgender health care, and will ensure that patients can continue to receive quality, legal, essential medical care in Rhode Island. 

“It’s wonderful to see the support of our legislature for this bill, which enables family doctors, OBGYNs, and other practitioners in Rhode Island to continue delivering high quality, essential care to our patients—including full-spectrum reproductive services and gender-affirming health care. The Health Care Provider Shield Act will protect our providers against actions from other states and allow us to deliver the standard of care and excellence that our patients deserve,” said Dr. Heather A Smith, RI Medical Society President and OBGYN. “We’re grateful to Senator Euer and Representative Edwards for their leadership on this legislation and working to ensure Rhode Island remains a state where clinicians want to practice, and where they can continue to provide our patients with quality, compassionate, and essential care when they need it.”

As multiple states have passed bans on abortion and transgender health care in recent years, authorities in some states, such as Texas, have also sought to intimidate or otherwise punish physicians or facilities in states who provide such essential care to their residents. Due to increasing threats, both Maine and Maryland moved swiftly to enact such laws in the last six months. At least 11 additional states and the District of Columbia have enacted health care shield laws to protect providers and patients and ensure their states remain desirable places to practice medicine. Four other New England states — including the neighboring states of Connecticut and Massachusetts, have similar shield laws to protect providers and access to care. 

“This is an important step toward securing critically needed safeguards for Rhode Island’s health care system. We’re heartened to see the legislature take urgently needed action this session to pass the Health Care Provider Shield Act,” said Polly Crozier, Attorney at GLBTQ Legal Advocates & Defenders. “Rhode Island has a strong public policy commitment to protecting access to health care, including reproductive and transgender health care. The Health Care Provider Shield Act aims to protect Rhode Island providers and patients from unwarranted out-of-state intrusion into medical decision making and ensure clinicians can continue to practice in line with the professional standards of care. Thank you to Senator Euer and Representative Edwards for successfully shepherding this bill through the legislative process.”

“Decisions about essential health care should be made by patients, their families, and their trusted care providers, not politicians. I’m grateful to my colleagues for taking this necessary next step to protect access to legal, standard-of-care health care for all who need it, along with the providers who deliver that care,” said Senator Euer. “I am proud and relieved, frankly, that the Health Care Provider Shield Bill is now on its way to Governor McKee, and I look forward to continuing to work with my colleagues to ensure the strongest possible protections for reproductive health care and for the health care needs of our transgender and LGBQ+ communities in Rhode Island.” 

The Health Care Provider Shield Act is supported by a provider-led coalition of more than 40 organizations, including the following health care associations and providers: the American Academy of Pediatrics, Rhode Island Chapter; American Association of Nurses- RI/Rhode Island State Nurses Association; American College of Emergency Medicine Physicians; American College of Obstetricians and Gynecologists; American College of Physicians, RI; East Bay Community Action Program; National Association of Social Workers; Nurse Practitioner Alliance of RI; Primary Care-Population Medicine MD-MSc Program Class of 2024; Rhode Island Academy of Family Medicine Physicians; Rhode Island Council of Child and Adolescent Psychiatry; Rhode Island Medical Society; Rhode Island Academy of Physicians Assistants; Spectrum; Hospital Association of Rhode Island; Open Door Health; Planned Parenthood of Southern NE; Thrive Behavioral Health; Thundermist Health Center; Rhode Island Health Center Association; and Wood River Health Services. 

“Today’s vote has brought us one step closer to protecting our provider community and the patients who rely on this essential care with the shield protections they need, deserve, and are requesting,” said Jeanne LaChance, President/CEO, Thundermist Health Center. “Rhode Island has a long history of supporting transgender people’s freedom to live without discrimination, including access to health care. When enacted, this bill will be one more example of Rhode Island’s leadership in protecting the rights of all Rhode Islanders to live safe and healthy lives.”

“Today, we celebrate the passage of the Health Care Provider Shield Bill, a testament to Rhode Island’s commitment to protecting the reproductive rights of all individuals. This victory sends a clear message that Rhode Island has our health care providers’ backs and supports them in delivering legally protected transgender and reproductive health care,” said Vimala Phongsavanh Senior Director, External Affairs at Planned Parenthood of Southern New England, “This is a momentous day for Rhode Island, and we are grateful to Senator Dawn Euer and Representative Edwards’ sponsorship of this legislation, and House and Senate leadership for once again affirming their commitments to championing reproductive health and rights for all.”

“I’m thankful to my colleagues in the House and Senate who voted for this important bill. The Health Care Provider Shield Act is about protecting established, best-practice medical care that is already legal in Rhode Island. This bill simply ensures that our local providers and our health care infrastructure aren’t negatively impacted by hostile laws in other states,” said Representative John “Jay” Edwards. “Politicians in multiple U.S. states are engaging in alarming government overreach, banning access to essential medical care and instituting civil and criminal penalties on providers for practicing medicine in line with the professional standards of care. This legislation will bring Rhode Island policy into alignment with laws in our neighboring states Massachusetts and Connecticut, and 11 additional states plus DC with similar laws, to ensure that these out-of-state statutes aren’t used against health care providers in Rhode Island.”

The Health Care Provider Shield Act Coalition also includes the ACLU of Rhode Island, Amnesty International USA, Center for Reproductive Rights, COYOTE, GLBTQ Legal Advocates & Defenders (GLAD), House of Codec, Protect Our Health Care RI, PPRI Votes, Pride in Aging, RI Coalition Against Domestic Violence, RI Commission on Human Rights, RI Coalition for Reproductive Freedom, RI Public Health Institute, RI State Council of Churches, The Trevor Project, The Womxn Project, TGI Network, and Youth Pride Inc.

Learn more about the bill.

News

Rhode Island House Passes Bill to Simplify Name Change Process

Bill sponsored by Rep. Robert Craven and Sen. Tiara Mack to remove barriers and safety risks for transgender people and domestic violence survivors seeking a legal name change now goes to Gov. McKee

Last night the Rhode Island House passed “An Act Relating to Probate Practice and Procedure—Practice in Probate Courts” (H. 8155) — a bill championed by advocates for LGBTQ+ people and survivors of domestic violence — by a vote of 68-2. Having been passed by the Senate earlier this month, the legislation now heads to Gov. McKee’s desk.

Sponsored by Reps. Robert Craven, Justine Caldwell, and Carol Hagan McEntee, H. 8155 simplifies the process for Rhode Islanders seeking to legally change their name by updating the statute on name change during divorce to be gender inclusive, allowing name change court costs to be waived for those who can’t afford them, removing the requirement for public notice or publication of a name change, and allowing name change records to be kept confidential if doing so is warranted by the person’s safety needs.

These reforms will alleviate barriers and safety risks for survivors of domestic violence and transgender people, two groups of Rhode Islanders who often seek legal name changes.

A companion Senate bill (S. 2667) sponsored by Sens. Tiara Mack, Melissa Murray, and Samuel Bell passed by a vote of 36 to 1 on May 7.

“We thank the House for taking this pivotal step toward simplifying Rhode Island’s name change process so that it’s more accessible to vulnerable residents,” said Polly Crozier, attorney at GLBTQ Legal Advocates & Defenders. “A legal name change makes it possible for transgender people’s identity documents to reflect their lived reality, enabling them to live more safely and freely and reducing barriers in important activities like applying for a job, making purchases, or even getting a library card. This legislation will allow transgender Rhode Islanders to obtain a legal name change without undue financial burdens or needing to out themselves to their local community via a public notice, which could invite harassment or discrimination. We’re grateful to Representative Craven for steering this bill through the House and for Senator Mack’s leadership in the Senate.”

“If an individual wishes to change their name, it should be an easy and simple process and not an overly complicated endeavor,” said Representative Craven. “This legislation will help relieve anxiety for applicants while also embracing an inclusive approach to support Rhode Island’s diverse population, including protections for those who may be harassed or persecuted for their gender or sexual identities and for victims of domestic violence.”

“This update in law will provide a more inclusive and easier process for Rhode Island’s residents who wish to change their name,” said Senator Mack. “The bill will also offer better protection for individuals who seek to change their name due to safety or other concerns. Nationwide attacks on the LGBTO+ community have left many communities with little hope for state legislatures to produce bills that protect rather than harm. As our society continues to evolve to a more inclusive and diverse whole, we must update our laws to reflect these changes and show solidarity for our LGBTQ+ neighbors, which this piece of legislation does.”

Title IX | National

In April of 2024, the U.S. Department of Education released a final rule that affirms that Title IX prohibits discrimination on the basis of sexual orientation, transgender status, and other sex-based characteristics and stereotypes.

This is a clear statement that federal law protects LGBTQ+ students from discrimination in public schools and that the Office of Civil Rights will investigate complaints.

The rule also reinstates broad protections and remedies for students who experience sex-based harassment, removing onerous complaint resolution procedures instituted by the prior administration, and providing much-needed updates regarding the rights of pregnant and parenting students.

Q&A

What does this new rule mean for my school?

The federal Department of Education has instructed all schools that receive federal funding to update or adopt policies that comply with these Title IX regulations.

When must my school/university implement the new Title IX regulations?

New Title IX regulations must be adopted by August 1, 2024

Who is better protected by the new regulations?

The final regulations provide greater clarity regarding: the definition of “sex-based harassment”; the scope of sex discrimination, including schools’ obligations not to discriminate based on sex stereotypes, sex characteristics, pregnancy or related conditions, sexual orientation, and gender identity; and schools’ obligations to provide an educational environment free from discrimination on the basis of sex (including LGBTQ+ students).

Does Title IX protect me as an LGBTQ+ student?

Yes! The rule prohibits discrimination and harassment based on sexual orientation, gender identity, and sex characteristics in federally funded education programs. The rule applies the reasoning of the Supreme Court’s ruling in Bostock v. Clayton County that discrimination on the basis of sexual orientation or transgender status is discrimination because of sex.

This means that schools must protect LGBTQ students from harassment and discrimination and cannot treat LGBTQ students differently from other students, including in sex-separated facilities – like access to bathrooms and locker rooms – and school programs.

Does the ruling say anything about transgender athletes?

The final regulations do not include specific language about sports.

However, several courts have said that banning all transgender girls from playing on girls’ sports teams or all transgender boys from playing on boys’ sports teams violates Title IX.

Are there exceptions to what Title IX covers?

Yes, there are some exceptions.

However, no one can be denied the benefits of the new regulations from educational institutions receiving federal financial assistance.

You can find further information regarding exemptions here.

State Laws and How to Get Help

  • It is important to note that in New England state laws also provide protections, sometimes greater than those at the federal level, and are often the first place to start when looking for support
    • You can find state-specific resources for dealing with bullying and harassment due to LGBTQ+ status or perceived status at schools here
  • If you have exhausted state-based resources or want to learn more about your rights under Title IX, you can find Title IX-specific information and resources here as well as the US Department of Education’s 2024 Ruling Fact Sheet here, where much of the information above has been pulled from
  • If you need more information or have questions about what to do if you or your child is experiencing discrimination, bullying, or harassment at school, contact GLAD Answers

A Note About Lawsuits Challenging the New Title IX Regulations

Some states that have passed anti-LGBTQ laws in recent years are currently challenging the new Title IX regulations in court.  However, no court rulings have yet been issued. Schools should be prepared to implement the new regulations by August 1, 2024.

Pride at School | National

Public schools have a responsibility to support and provide a positive environment for all students.

One way that they do this is by displaying support for LGBTQ+ students through Pride symbols and flags.

Public school administrators are legally required to provide the same rights to all students and student clubs under the Equal Access Act. So, for example, if the school allows students from other clubs to hang flags or banners, the school has a legal responsibility to allow their GSA (Gender and Sexuality Alliance) to do the same.

At schools, school officials are able to create guidelines around displaying supportive flags and symbols. Just because they display supportive imagery does not mean that they also need to display offensive imagery if requested to do so. Schools do not need to worry about being forced to put up offensive banners, decorations, or other imagery.

This means schools can fly flags like the Black Lives Matter or Transgender Pride flags to show support for their students. Schools do NOT have to take down these flags, even if someone requests it as a hostile symbol.

What can schools do?

  • Keep up existing inclusive flags, signs, and posters.
  • Have school faculty meetings where school employees propose new inclusive displays.
  • Put up new inclusive displays to show support for their students.
  • Provide all student clubs with the same resources.

What should schools not do?

  • Schools should not create programs that allow private individuals to propose flag suggestions.
  • Schools should not let non-school employees put up displays.
  • Schools cannot allow only some groups of students to have clubs and exclude others.

College | National

Every student is entitled to equal educational opportunities and an environment that supports them. They also deserve to show up as and express their authentic selves, which includes having their proper name and pronouns used in classroom and administrative settings. For LGBTQ+ college students, this can prove difficult as there are no overarching policies or laws regarding name and pronoun usage at universities. Public universities often have more protections for LGBTQ+ students whereas private and religious educational institutions may follow different policies. Below you can find some information on best practices and ideas on how to best approach the subject with staff, professors, and administration. The links and resources provided were not compiled by GLAD and have not been vetted by GLAD.

Applying to LGBTQ+ Friendly Universities

Name & Pronoun Use and the Common App

Due to the Common App (a platform that allows students to use one college application to apply to several universities) asking students for their (preferred) names and pronouns, as of January 2022 over 900 universities across the US now have the ability to integrate the use of those names and pronouns, and over 200 universities directly use this information in their campus information systems.

Here you can find a list from August 2023 of The Best Colleges for LGBTQ+ Students in the US. You can also use the Campus Pride Index.

Pronoun and Name Usage on Campus

Professors using your correct name and pronouns:

All students deserve to be treated with respect. One way professors can be respectful is by asking for and using students’ correct name and pronouns (even if they differ from what’s on the students’ records).

If you are being named incorrectly and misgendered here are some steps you can take to advocate for yourself:

  • Bring it up to the person misgendering or misnaming you. They may not be aware that they are doing so and might be able/willing to easily change this.
  • Share resources. You can find GLSEN’s Pronouns Guide here.
  • Start a conversation on campus and advocate for campus-wide change. Connect with Campus Pride to take their trainings and use their LGBTQ+ advocacy resources.
  • Go to the Title IX Office. Persistent, intentional misgendering is also something you can raise with the Title IX Office at your university.

Updating your preferred name and pronouns with the registrar’s office:

Some universities now give students the ability to update their name and pronoun information at the registrars’ office so as to not out trans students to their professors and other campus staff. Check out this example of a policy to update for preferred (not legal) names and pronouns from Berklee College of Music.

If your school does not have such a policy and/or is refusing to allow you to update your name and pronouns through the registrar’s office, you may be able to make a Title IX complaint. Title IX protects LGBTQ+ students from discrimination based on sexual orientation and gender identity. Read more about Title IX here.

Because of FERPA protections, if you are over 18, by law you are able to update your name and pronouns at your college without that information being shared with your parents, guardians, spouse, or financial benefactors.

Advocating for correct name and pronoun usage on campus:

Campus Pride has great advocacy trainings and resources for students.

University Policies, Best Practices, Etc.

Guides for universities looking to update their practices

Below, university administration, professors, and staff can find guides on supporting LGBTQ+ students in higher education:

GLAD Answers

If you’ve followed these steps and the situation has not resolved or is getting worse, please reach out to GLAD Answers. Complete the online intake form at GLADAnswers.org, email GLADAnswers@glad.org, or leave a voicemail at 800-455-GLAD.

News

Legislation sponsored by Senator Tiara Mack and Representative Robert Craven would remove barriers and safety risks for transgender people and survivors of domestic violence seeking a legal name change

Today the Rhode Island Senate passed “An Act Relating to Probate Practice and Procedure—Practice in Probate Courts” (S. 2667) – a bill championed by advocates for LGBTQ+ people and survivors of domestic violence – by a vote of 36 to 1.

Sponsored by Sens. Tiara Mack, Melissa Murray, Samuel Bell, S. 2667 simplifies the process for Rhode Islanders seeking to legally change their name by updating the statute on name change during divorce to be gender inclusive, allowing name change court costs to be waived for those who can’t afford them, removing the requirement for public notice or publication of a name change, and allowing name change records to be kept confidential if doing so is warranted by the person’s safety needs.

These reforms will alleviate barriers and safety risks for survivors of domestic violence and transgender people, two groups of Rhode Islanders who often seek legal name changes.

A companion House bill, H 8155, is sponsored by Representatives Robert Craven, Carol McEntee, and Justin Caldwell.

“We’re grateful for the Senate’s strong support for this bill which expands the circle of protection, respect, and equity to include more Rhode Islanders,” said Polly Crozier, Attorney at GLBTQ Legal Advocates & Defenders. “A legal name change makes it possible for transgender people’s identity documents to reflect their lived reality, enabling them to live more safely and freely and reducing barriers in important activities like applying for a job, making purchases, or even getting a library card. This bill will make it more accessible for transgender Rhode Islanders to obtain a legal name change without undue financial burdens or needing to out themselves to their local community via a public notice, which could invite harassment or discrimination. Many thanks to Senator Mack for her leadership in the Senate and to Representative Craven for moving this important bill in the House.”

“This update in law will provide a more inclusive and easier process for Rhode Island’s residents who wish to change their name,” said Senator Mack. “The bill will also offer better protection for individuals who seek to change their name due to safety or other concerns. Nationwide attacks on the LGBTO+ community have left many communities with little hope for state legislatures to produce bills that protect rather than harm. As our society continues to evolve to a more inclusive and diverse whole, we must update our laws to reflect these changes and show solidarity for our LGBTQ+ neighbors, which this piece of legislation does.”

“If an individual wishes to change their name, it should be an easy and simple process and not an overly complicated endeavor,” said Representative Craven. “This legislation will help relieve anxiety for applicants while also embracing an inclusive approach to support Rhode Island’s diverse population, including protections for those who may be harassed or persecuted for their gender or sexual identities and victims of domestic violence.”

News

Advocates, Providers Praise Senate Passage of Bill to Safeguard Rhode Island’s Health Care System, Access to Essential Care

Health Care Provider Shield Act limits risk of hostile out-of-state laws related to abortion, transgender health care

Update: Senator Gu has now added her vote in support of SB2262, bringing the final vote count to 30-7.

Advocates for health care access, reproductive health care, and LGBTQ+ equality praised the Rhode Island Senate for passing the “Health Care Provider Shield Act,” (SB2262/HB7577) by a vote of 29 to 7. The bill will protect the state’s health care system, doctors, other medical care providers, and patients from hostile out-of-state laws that could negatively impact delivery of care.

Sponsored by Senator Dawn Euer and Representative John G. Edwards, the Health Care Provider Shield Act will ensure that Rhode Island health care providers aren’t penalized under the laws of other states that have banned access to established, standard-of-care reproductive and transgender health care, and that patients can continue to receive quality, legal, essential medical care in Rhode Island.

“We’re grateful for the Senate’s prompt action in favor of this bill, which enables family doctors, OBGYNs, and other practitioners in Rhode Island to continue delivering high quality, essential care to our patients—including full-spectrum reproductive services and gender-affirming health care. This bill will protect our providers against actions from other states and allow us to deliver the standard of care and excellence that our patients deserve,.” said Dr. Heather A Smith, RI Medical Society President and OBGYN. “We need the Health Care Provider Shield Act to ensure Rhode Island remains a state where clinicians want to practice, and so that physicians can continue to provide our patients with quality, compassionate, and essential care when they need it.”

As multiple states have passed bans on abortion and transgender health care in recent years, authorities in some states, such as Texas, have also sought to intimidate or otherwise punish physicians or facilities in other states who provide such essential care to their residents. At least a dozen other states and the District of Columbia have already passed health care shield laws to protect providers and patients and ensure their states remain desirable places to practice medicine. Four other New England states – Connecticut, Massachusetts, Vermont, and Maine, where Governor Mills signed a bill into law last month – have similar shield laws to protect providers and access to care. 

“This is a big step toward securing critically needed safeguards for Rhode Island’s health care system. We are grateful to both Sen. Euer and Representative Edwards for their leadership on this bill and thank the Senators who voted to support it today,” said Polly Crozier, Attorney at GLBTQ Legal Advocates & Defenders. “Rhode Island has a strong public policy commitment to protecting access to health care, including reproductive and transgender health care. The Health Care Provider Shield Act protects Rhode Island providers and patients from unwarranted out-of-state intrusion into medical decision making and ensures clinicians can continue to practice in line with the professional standards of care.”

The Health Care Provider Shield Act is supported by state health care associations and providers, including the American Academy of Pediatrics, Rhode Island Chapter, American Association of Nurses- RI/Rhode Island State Nurses Association, American College of Emergency Medicine Physicians, American College of Obstetricians and Gynecologists, American College of Physicians, RI, National Association of Social Workers, Nurse Practitioner Alliance of RI, Primary Care-Population Medicine MD-MSc Program Class of 2024, Rhode Island Academy of Family Medicine Physicians, Rhode Island Council of Child and Adolescent Psychiatry, Rhode Island Medical Society, Rhode Island Academy of Physicians Assistants, Spectrum, Hospital Association of Rhode Island, Open Door Health, Planned Parenthood of Southern NE, Thrive Behavioral Health, Thundermist Health Center, Rhode Island Health Center Association, and Wood River Health Services. 

The Health Care Provider Shield Act will:

  • Protect Rhode Island healthcare providers from abusive civil or criminal litigation from other states
  • Protect Rhode Islanders from having their information about protected health care shared with law enforcement agencies in other states where such care is banned
  • Ensure Rhode Island providers aren’t unfairly penalized by health care institutions or insurance for providing legally protected health care consistent with the professional standards of care
  • Protect health care providers from surveillance that could negatively impact their ability to provide legally protected care
  • Protect all providers involved in delivering legally protected transgender and reproductive healthcare in Rhode Island consistent with the professional standards of care, including care via telehealth
  • Ensure Rhode Island’s resources are not used to further hostile litigation from states where essential healthcare is banned

“This is a good day for patients and providers alike. Penalizing providers for delivering effective, best-practice medical care takes away patients’ ability to make informed decisions about their own and their children and families’ health,” said Jeanne LaChance, President/CEO, Thundermist Health Center. “Rhode Island has a long history of supporting transgender people’s freedom to live without discrimination, including in access to health care. We deeply appreciate the Senate’s vote to uphold that standard.”

“Today, the Senate underscored the significance of patient access to legal, standard-of-care transgender and reproductive health care, as well as the protection of providers delivering these essential services in Rhode Island,” stated Vimala Phongsavanh, Senior Director of External Affairs at Planned Parenthood of Southern New England. “With more states nationwide moving to ban abortion and transgender health care, patients and providers continue to face heightened health and legal risks. We are grateful for Senator Euer’s leadership and look forward to working with Representative Edwards to pass the Health Care Provider Shield Act in the House.”

“I’m thankful to my colleagues who voted for this important legislation. The Health Care Provider Shield Act is about protecting established, best-practice medical care that is legal in Rhode Island and ensuring that our local providers and our health care infrastructure aren’t negatively impacted by hostile laws in other states,” said Senate Judiciary Chair Euer. “Politicians in multiple U.S. states are engaging in alarming government overreach, banning access to essential medical care and instituting civil and criminal penalties on providers for practicing medicine in line with the professional standards of care. This bill will ensure that these out-of-state laws aren’t used against health care providers in Rhode Island.”

“Decisions about essential health care should be made by patients, their families, and their trusted care providers, not politicians. It is critical that Rhode Island take steps to protect access to legal, standard-of-care health care for all who need it, along with the providers who deliver that care,” said Representative Edwards. “I look forward to working with my colleagues in the House to quickly pass the Health Care Provider Shield Act.” 

The Health Care Provider Shield Act is also supported by a coalition of organizations including the ACLU of Rhode Island, Amnesty International USA, Center for Reproductive Rights, COYOTE, East Bay Community Action Program Rhode Island, GLBTQ Legal Advocates & Defenders (GLAD), House of Codec, Protect Our Health Care RI, PPRI Votes, Pride in Aging, RI Coalition Against Domestic Violence, RI Commission on Human Rights, RI Coalition for Reproductive Freedom, RI Public Health Institute, RI State Council of Churches, The Trevor Project, The Womxn Project, TGI Network, and Youth Pride Inc.

Learn more about the bill

News

60+ Rhode Island Organizations Urge General Assembly to Reject Harmful Legislation Targeting LGBTQ+ People

Organizations are joined by 400+ individual signers from across the state including medical providers, behavioral health providers, teachers, parents, and other concerned Rhode Islanders

A coalition of local organizations, advocates, and community members have sent an open letter to Rhode Island legislators urging them to reject a series of proposed bills that would undermine the well-being of LGBTQ+ people in the state.

The letter was signed by over 60 organizations, including the National Education Association Rhode Island, Rhode Island Medical Society, Rhode Island Academy of Family Physicians, Rhode Island Chapter of the American Academy of Pediatrics, Rhode Island Council of Child and Adolescent Psychiatry, Rhode Island Psychological Association, Rhode Island Section of American College of Obstetrics and Gynecology, Rhode Island Coalition for Children and Families, Rhode Island Coalition Against Domestic Violence, Rhode Island Black Business Association, and Rhode Island Commission for Human Rights.

“The majority of Rhode Islanders support equality, and we’ve proven that from one legislative session to the next,” the letter reads. It describes a series of proposed bills that target LGBTQ+ people and “run counter to our commitment to protect our families, friends, and neighbors,” including: 

  • A dangerous bill that would ban standard-of-care medical care for transgender youth – care that is supported as safe and effective by every major U.S. professional medical association, taking away parents’ ability to get their children the healthcare they need, as well as removing established protections in healthcare insurance coverage (H7884, S2703)
  • Bills targeting transgender students for exclusion by prohibiting them from playing on school sports teams with their friends and potentially subjecting any female student athlete to invasive medical exams (H7727, S2660)
  • Proposals which would threaten schools and teachers with penalties for not complying with vague requirements to allow virtually any individual parent to dictate school lesson plans, remove teachers’ and school staffs’ ability to support LGBTQ+ students in school, and mandate the forced outing of LGBTQ youth without regard to students’ safety (H7781, S2424, H7873, S2041)
  • A bill that could be used to classify any material with LGBTQ+ content as obscene and levy criminal charges (S2104)
  • A dangerous bill that would threaten the health of every Rhode Islander by allowing any medical provider, healthcare facility, or insurance plan to refuse to provide care based on the vague assertion that it violates their conscience (S2423)

The letter, which was also signed by over 400+ individual Rhode Islanders – including medical providers, behavioral health providers, teachers, parents, and other concerned residents – from towns across the state, goes on to read:

“Rhode Island protected transgender people under the law more than 20 years ago, recognizing that as the necessary first step to end the mistreatment too often experienced by the community. Nearly a decade has passed since our schools implemented policies to support transgender, nonbinary, and gender diverse students. We should be well beyond debates about transgender Rhode Islanders’ basic dignity and humanity and respect for their ability to live, work, go to school and participate in public life on the same terms as everyone else.”

“Rhode Islanders want our elected senators and representatives to work on policies that will actually improve the lives of everyone in the Ocean State, not stir up baseless fear about a small group of people.”

The organizations signing the letter are:
Thundermist Health Center
TGI Network of Rhode Island Inc.
Youth Pride, Inc.
Sojourner House
Project Weber/RENEW
Haus of Codec
Pride in Aging RI
Newport Pride
PFLAG Greater Providence
The Womxn Project
Young Voices
Rhode Island ACLU
Rhode Island Commission for Human Rights
National Education Association Rhode Island
Rhode Island KIDS COUNT
Economic Progress Institute
Women’s Fund of Rhode Island
SHIP
COYOTE RI
Amnesty International USA 1016
GLBTQ Legal Advocates & Defenders
The Trevor Project
Planned Parenthood of Southern New England
Rhode Island Public Health Institute
Open Door Health
Family Service of Rhode Island
Thrive Behavioral Health
Rhode Island Medical Society
Rhode Island Academy of Family Physicians
Rhode Island Chapter of the American Academy of Pediatrics
Rhode Island Council of Child and Adolescent Psychiatry
Rhode Island Psychological Association
Rhode Island Section of American College of Obstetrics and Gynecology
Washington County Health Equity Zone
One Cranston Health Equity Zone
Protect Our Healthcare Coalition RI
Rhode Island Coalition for Children and Families
Rhode Island Coalition Against Domestic Violence
SafeBAE
Haven Box
Women’s Health & Education Fund
Rhode Island State Council of Churches
Hope and Change Partnership
Rhode Island Democratic Party LGBTQ+ Caucus
RI Working Families Power
Rhode Island Black Business Association
East Greenwich Pediatrics
Trident Psychological Services
East Side Psychotherapy, Inc.
Ann Adler, Ph.D., LLC
Providence Wellness, LLC
Radically Thrive Therapy, LLC
Wilder Therapy & Wellness
Bellwether Doulas
OkaySo
Secular Student Alliance
Rhode Island Atheists
Humanists of Rhode Island
Barrington United With Pride
Towards an Anti-Racist North Kingstown (TANK)
People Respecting Others With Dignity! (PROWD!)
Ryder | Talbutt Group
FabNewport
Carberry Development Group
CJG Notary of RI, LLC
Public Shop & Gallery
Sharper Harper LLC

And an additional 400+ individual signatures from across the state including medical providers, behavioral health providers, teachers, parents, and other concerned Rhode Islanders

Read the full letter is available

Read a fact sheet on the proposed bills

School Resources | Youth | Rhode Island

Schools are meant to be student-centered places where young people are safe and can learn what they need to succeed in life. Yet, extremist politicians and well-funded national groups are trying to make public schools and school libraries a site of attacks on LGBTQ+ people, especially youth, and families. 

Youth in Rhode Island public schools still have rights, and our schools have a responsibility to ensure all students, including LGBTQ+ students, are safe, supported, and able to learn. GLAD and our partners are sharing these resources on your rights as a student, parent, and educator.

Find national resources and organizations here.

Rhode Island Resources

Know Your Rights

Nondiscrimination: Rhode Island General Laws prohibit discrimination in educational programs, opportunities and other matters based on gender identity, sex, sexual orientation, and perceived sexual orientation in Rhode Island public schools.  You can read more under R.I. Gen. Laws § 16-38-1.1 

Anti-Bullying: Rhode Island has strong anti-bullying laws. It has strict requirements that schools must follow to protect students from a wide variety of bullying, be it physical, verbal, or online.  

Guidance for Schools: The Rhode Island Department of Elementary and Secondary Education has created guidance in 2016 for schools on the rights, responsibilities, and best educational practices for transgender and gender non-conforming students. Learn more about the guidance and contact the Department of Education for more information.

Learn more about youth rights in Rhode Island on the following Know Your Rights pages

What to do if you or your child is experiencing bullying, discrimination, or mistreatment in school

If you as a student or your child is experiencing bullying because of an LGBTQ+ status or a perceived LGBTQ+ status, you can take steps under your local policy as well as state and federal law to remedy the situation. And you can pursue both avenues at the same time. 

Rhode Island Anti-Bullying & Harassment Protections 

First, it is important to understand what Rhode Island considers bullying or harassment.  

Rhode Island anti-bullying laws include the following definitions of bullying: “Bullying” means the use by one or more students of a written, verbal or electronic expression or a physical act or gesture or any combination thereof directed at a student that: 

  • Causes physical or emotional harm to the student or damage to the student’s property; 
  • Places the student in reasonable fear of harm to himself/herself or of damage to his/her property; 
  • Creates an intimidating, threatening, hostile, or abusive educational environment for the student; 
  • Infringes on the rights of the student to participate in school activities; or 
  • Materially and substantially disrupts the education process or the orderly operation of a school. The expression, physical act or gesture may include, but is not limited to, an incident or incidents that may be reasonably perceived as being motivated by characteristics such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression or mental, physical, or sensory disability, intellectual ability or by any other distinguishing characteristic. 

Read more from StopBullying.gov FAQ

Second, consider whether you want to take action under the school’s anti-bullying or harassment policies, which should be available on the school website. If so, follow the steps from the school’s policies, keep copies/screenshots of emails and texts, and take notes of conversations with school staff to show that you have done what you are supposed to and that the school is on notice of your concerns.

If the school is not investigating the bullying, press them to do so. Rhode Island’s Safe School Act Statewide Bullying Policy “recognizes that the bullying of a student creates a climate of fear and disrespect that can seriously impair the student’s health and negatively affect learning. Bullying undermines the safe learning environment that students need to achieve their full potential.  The purpose of the Policy is to ensure a consistent and unified statewide approach to the prohibition of bullying at school.” See the full policy from 2012 here, and information Rhode Island Kid’s Count Bullying Prevention Brief from 2016 here. 

If you are not satisfied with the school’s response, consider contacting the school district’s Superintendent (information on the school website). 

If working with the administration and superintendent is not helpful, the RI Department of Education is the next place to turn.  You can contact Thrive, a part of the State government devoted to healthy and safe learning environments.

Under a Board of Regents Policy adopted in 1997 and revised in 2010, all students, without exception, have the right to attend a school in which they feel safe and able to express their identity without fear… certain students, because of their actual or perceived sexual orientation or gender identity/expression, have been subject to discrimination through abuse, harassment, bullying and/or exclusion from full participation in educational activities. You can find more information here and here.

You may also choose to file a discrimination complaint with the Rhode Island Commission for Human Rights. Find out more.

US Harassment & Discrimination Protections for Students 

Federal law is also a tool for addressing bullying and harassment.  When these behaviors are ignored or inadequately addressed, this may add up to discrimination or the denial of education opportunities based on sexual orientation or gender identity, among other characteristics.  

You can raise concerns about your or your child’s experience of discriminatory anti-LGBTQ+ bullying, harassment, or other discrimination by contacting contact the U.S. Department of Education Office of Civil Rights in Boston to file a complaint. The OCR has the authority to investigate a complaint of discrimination on the basis of race, color, national origin, sex, disability, or age. Note that sexual orientation and gender identity discrimination are aspects of “sex” discrimination.  

Contact the Office of Civil Rights. 

Harassment and bullying because of a person’s LGBTQ+ status may also constitute sex discrimination under Title IX protections. Read more about the US Department of Education’s updated guidance on Title IX.  

If you have questions about the specific situation you are experiencing or questions that have not been answered above, please reach out to GLAD Answers

Get involved in your local community

  • Follow the issues that come up in your school committee and town/city council
  • Attend meetings when important issues are being discussed and even to participate in the public comment period in which School Board/Committee members listen to input from the public.  It is important that they hear support for good work and good arguments for why LGBTQ+ and race-based restrictions are bad educational policy for all students.
  • Follow education, curriculum, staffing, policy, library and other issues in school board and local elections, or run for office yourself
  • For support in talking about issues related to education and LGBTQ+ students, and more ways to take action, visit Campaign for Our Shared Future.

Organizations and Additional Resources

Organizations

For more youth-focused organizations, visit Youth Organizations | Rhode Island

Additional Resources

LGBTQ+ Youth Resource Lists:

Want to learn more about LGBTQ+ Equality in Rhode Island? Visit the Movement Advancement Project’s Rhode Island Equality Profile.

GLAD Answers

Still have questions? Contact GLAD Answers for free and confidential legal information, assistance, and referrals. Complete the online intake form at GLADAnswers.org, email GLADAnswers@glad.org, or leave a voicemail at 800-455-GLAD.

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