Over the past year, the University of Vermont Health Network has been changing the questions that registration staff ask at the system’s six hospitals and its home health and hospice facility.
A broader age range of patients are now asked about their gender identity, and everyone 12 and older is asked their sex assigned at birth. The intent, according to the hospital system, is to improve care for the trans and nonbinary community.
But advocates in that community say they haven’t been told about the rollout of these questions. And they say that as trans and nonbinary people face risks to their safety under the current presidential administration, institutions need to be especially transparent.
What UVM Health Network is doing
UVM Medical Center Vice President of Culture, Experience and Community Health Dr. Marissa Coleman said the UVM Health Network’s updated questions about gender identity and sex assigned at birth are meant to get a better picture of the patient population in order to make care more inclusive, including using someone’s lived name, correct pronouns and gender.
“We can't treat folks with full dignity and respect if we don't know them,” Coleman said. “The ways in which gender identity was being asked was not consistent and also didn't align with best practice in the field of LGBTQ-affirming health care.”
As an example, she said hospitals in the network previously only asked about gender identity if a patient was 18 or older.
“But we know that gender identity is something that's fluid, and oftentimes can crystallize even before the age of 18,” Coleman said.
Then, in October 2024, the UVM Health Network put into effect a Biden-era federal requirement, from the Centers for Medicare and Medicaid Services, and started asking people 12 and older their sex assigned at birth.
Coleman noted that this question was already under consideration for the updated registration scripts.
And while the new language made clear that patients could decline to answer, and that the reason for the question was so clinical teams could provide the most appropriate care — Coleman said the rollout of this language was “clunky.”
“I am aware that some of the language that had been used, that was not a part of our recommendations, included ‘the government is requiring us to ask the question,’ and that's alarming,” she said. “It’s not fully accurate, and also it’s not what we would want anybody to be hearing when they’re coming into the care environment, particularly in this federal climate.”
The current federal climate includes a series of anti-trans executive orders from the Trump administration and similar legislation moving through Congress. In the version of the budget bill recently passed by the U.S. House, for instance, there’s a ban on federal Medicaid coverage for gender-affirming medical care. That bill is currently in the Senate.
The impact for trans, nonbinary communities
“This is a terrifying and unstable moment for so many,” said Dana Kaplan, the executive director of Outright Vermont, which serves LGBTQ+ youth. “Trans youth in particular are being targeted, stripped of their ability to participate in public life, from schools to sports to medically necessary health care.”
Because of this fear, Kaplan said it’s extra important for institutions to share information early and often around policies impacting trans and nonbinary people, like being asked to share their gender identity and sex assigned at birth.
“We know that for some trans young people, it will feel affirming and helpful to have that question asked, to say that ‘we understand that your sex assigned at birth may be different from your gender identity,’” he said. “For others, for young people who are stealth, who are not out, it will be really, really dangerous.”
But in the case of the UVM Health Network’s newer registration questions, Kaplan said there hasn’t been any messaging: Outright Vermont didn’t know about them until Vermont Public reached out for an interview.
Pride Center of Vermont Health and Wellness Director Kell Arbor was at one point included in UVMMC’s discussions about updating the hospital network’s registration questions, but said that was months ago.
Since then, Arbor also hasn’t seen any messaging around the gender identity and sex assigned at birth questions.
“I hope they have a plan to roll out through their partners like Outright [Vermont], to update families and let folks know what to expect,” Arbor said.
Arbor and Kaplan said they appreciate the efforts UVM Health Network is making to improve care access for trans and nonbinary people, including through more thorough data collection — and recognize that it’s a big system to change.
But Kaplan said systems are already not designed for trans and nonbinary people. And that to meet that community’s needs, they have to be at the center of the process.
“We have to really understand what the clear path forward is for how safety is being guaranteed and how this data is being protected,” he said.
How UVM Health Network will go forward
Coleman, with UVMMC, said the fear described by Kaplan is “valid and it’s real,” and that it’s also felt by herself and many staff. As far as data privacy, she said all patient-identifying information collected at registration remains protected by HIPAA.
“We're aware that things have been changing rapidly in this climate, and so we've actually felt that that is all the more reason to have very specific, scripted language,” Coleman said. “So that the question is being asked consistently, that there is more oversight — and for lack of better word, control — in how the data is collected, because we understand the risks.”
She said the hospital was committed to strengthening its partnership with Outright Vermont and the Pride Center of Vermont.
