Though Pride Month is celebrated once a year, gender-affirming care and LGBTQ+ health equity are year-round work. Community health workers are often the most direct connection between LGBTQ+ individuals and a healthcare system that has, historically, given them significant reasons not to trust it.

The scale of that distrust is grounded in data. 

According to OutCare Health, more than 50% of LGBTQ+ people report experiencing discrimination in healthcare settings. One in five transgender people has been denied care because of their gender identity. Suicide attempt rates among LGBTQ+ youth are four to 10 times higher than among their peers, suggesting disproportionately high rates of LGBTQ+ mental health concerns. LGBTQ+ individuals currently represent roughly 10% of the U.S. population, and nearly 30% of Gen Z, according to OutCare Health. This is a large population receiving inadequate care.

For community-based organizations (CBOs) and CHWs, the consequences are immediate. Fortunately, even if not a part of the LGBTQ+ community, providers can learn skills that foster more inclusive, affirming care, and it starts with understanding the context. 

The history behind the distrust

Homosexuality was classified as a mental health disorder until 1973. That history is not abstract. The stigma it produced persists in how LGBTQ+ individuals experience medical encounters today. The HIV and AIDS crisis of the 1980s and 1990s deepened that distrust as government and medical institutions were slow to respond, and LGBTQ+ communities largely built their own care infrastructure as a result.

Today, LGBTQ+ individuals still regularly encounter providers who expect them to explain their identity, correct misgendering mid-appointment, or justify why their care needs are different from what the provider assumed. When LGBTQ+ people experience discrimination in healthcare settings, they stop coming back and preventable conditions go untreated.

Intersectionality compounds these barriers. For individuals who are trans and Latino, or LGBTQ+ and undocumented, or queer and navigating a language barrier, the layers don’t simply add boxes, they interact. Each exclusion shapes how safe it feels to disclose information, ask for help, or return after a difficult encounter. As a result, organizations such as El/La Para Trans Latinas exist specifically because the intersection of trans identity and Latina identity requires culturally specific, linguistically competent care that general LGBTQ+ services don’t always provide. But they’re not the only ones doing it. 

Inclusive care in practice: What CHWs can do now

Inclusive care for LGBTQ+ clients does not require a clinical specialty or a program overhaul. The most impactful changes are specific and immediately actionable. 

Redesigning intake forms for LGBTQ+ clients

Every CHW knows that every client must have a paper trail, especially when billing Medicaid for CHW services. This starts with an intake form. Intake forms are the first signal a client receives about whether a space is safe for them. Binary gender fields, legal-name-only fields, and forms that conflate sex assigned at birth with gender identity communicate, even unintentionally, that the organization hasn’t considered this population. Simple changes make a measurable difference:

• Ask for a chosen or preferred name separately from legal name.
• Separate sex assigned at birth from gender identity.
• Add a pronouns field and use it consistently throughout the interaction.
• Replace binary gender options with inclusive alternatives.

Clients are far more likely to disclose accurate, complete information when the form itself signals that all answers are welcome.

Affirming communication starts with asking, not assuming

The most common mistake CHWs make with LGBTQ+ clients is assuming: gender from appearance, sexuality from a relationship, or preferences from silence. Entering each interaction with genuine openness about who someone is and what they need bypasses those assumptions before they cause harm. If you don’t know someone’s pronouns or preferred name, ask. Just like you would when pronouncing a name you’ve never encountered before. 

Asking is not offensive. Getting it wrong repeatedly without asking is.

How to recover from misgendering in the moment

Mistakes happen. The right response is acknowledging what you got wrong, saying what you’ll do differently, and moving on. An extended apology shifts the emotional weight onto the person you’re serving as they end up managing your discomfort about a mistake you made. 

Why confidentiality conversations matter for LGBTQ+ clients

For many LGBTQ+ clients, disclosing identity to a CHW, in a medical record, or anywhere else carries real risk. That risk may be legal, familial, emotional, or related to immigration status. Don’t assume clients know their information is protected. Tell them explicitly how it is stored, who can access it, and what confidentiality means in your specific setting, affirming trust and understanding. 

Language access as a core component of LGBTQ+ inclusive care

Language access is not a secondary concern. For Spanish-speaking or other non-English-speaking LGBTQ+ clients, it frequently determines whether care is accessible at all. If translation services aren’t embedded in your organization’s workflow, that gap is worth raising internally. Organizations that have language access resources become ones that LGBTQ+-serving networks can confidently refer to.

Finding LGBTQ+-affirming partners and referral networks

Across the country, community-based organizations are building the infrastructure for LGBTQ+-inclusive care. CHWs don’t have to navigate this alone. There are organizations specifically designed to support this work, and connecting with them directly strengthens your ability to serve LGBTQ+ clients.

OutCare Health operates the OutList, the largest directory of LGBTQ+-affirming providers in the United States. Providers are verified individually rather than scraped or data-mined, which is what makes it a trustworthy referral resource. CHWs can create free profiles and be discoverable by community members seeking affirming support across all 50 states and more than 50 specialties. OutCare also offers 29 provider trainings, many with continuing education units, Spanish subtitles, and accessibility across the nation. 

Organizations like El/La Para Trans Latinas, a San Francisco-based CBO providing culturally responsive care specifically for transgender Latina community members, represent the kind of population-specific, intersectional care model that fills gaps general LGBTQ+ services don’t always reach. Their workforce development and leadership programs for community members are free and typically stipended for San Francisco-area participants.

These are two examples. Pear Suite works with many LGBTQ+-serving organizations across the country, and the referral directory built into our platform connects CHWs to affirming partners in their region, so the right referral is accessible from within the same system where the rest of the work is documented.

How Pear Suite supports LGBTQ+-inclusive care

Federal grant funding cuts are a real and immediate threat to LGBTQ+-serving CBOs. The financial pressure is reshaping what organizations can sustain right now.

In many states, much of the care coordination, outreach, referral, and navigation work LGBTQ+-serving organizations already do qualifies for Medicaid reimbursement as community health worker services. Organizations not yet billing for CHW services are leaving a significant and stable funding stream on the table. Pear Suite supports that transition from grant dependency to reimbursable care.

For LGBTQ+-serving organizations watching grant funding contracts in real time, the CHW benefit represents a more stable and sustainable revenue pathway — one that compensates organizations for work they’re already doing.

LGBTQ+ health equity is year-round work

CHWs, regardless of their own identity, are often the most important connective tissue between this population and a healthcare system still working to earn their trust.

Inclusive care does not require a specialty certification. It requires updated intake forms, a referral directory of affirming providers, a willingness to ask instead of assume, and the infrastructure to document and bill for the work, so the organizations supporting these clients can sustain themselves and stick around. 

To explore what billing for CHW services could look like for your organization, or to connect with Pear Suite’s partner network, connect with our partnership team.