Problems, Policies, and Solutions
This page is our guidebook to some of the biggest problems that affect the LGBTQ+ community in Arizona. Browse through each section to learn about the policies behind the problems, as well as some of the possible solutions we’ve identified. From healthcare to housing to criminal justice, there’s a lot here, but if you take away just one thing, we’d like it to be this — the problems facing our community aren’t just problems, they're policy decisions, and that means we can choose differently.
On This PageAHCCCS
The Problem
While some forms of gender affirming care are accessible through Arizona’s Medicaid program, AHCCCS, major obstacles still exist for transgender individuals seeking lifesaving care through the system. Notably, surgical transition care is unavailable — which may come as no surprise given the legislature’s hostile attitude towards gender affirming care in general — but this lack of care extends so far as to make some trans patients ineligible for essential cancer screenings.
The Policy
So where are these decisions being made? As a state agency, AHCCCS follows policy laid out in the Arizona Administrative Code, specifically Title 9. For our purposes, we’re looking at a handful of rules in Chapter 22 of Title 9 of the AAC. Reading it through, it turns out that the lack of coverage for gender affirming surgeries isn’t an accident of omission, but a conscious exclusion (see R9-22-205 B 4). It really is that specific. Further down in the same chapter, in R9-22-2003, part E sets out the eligibility criteria for the breast and cervical cancer treatment program. Instead of defining those criteria based on medical need, it just makes all male individuals ineligible by default, creating a major health risk for trans men and other trans masculine individuals who have updated their legal gender markers.
The Solution
With a new governor and a new administration, we also have new directors for our state agencies, including AHCCCS. As they embark on the rulemaking process, these are the kinds of questions they’ll have the opportunity to consider. And with a policy problem that boils down to one line of administrative code, the policy solution can be similarly succinct. Exclusions can be lifted, eligibility criteria can be refactored to benefit all patients, and new rules and definitions can be put in place to ensure equitable access for all.
Marriage Equality
The Problem
It’s been almost a decade since Arizona won marriage equality through a 2014 district court ruling in Connolly v. Jeanes and Majors v. Horne. The year later, the U.S. Supreme Court established a fundamental right to marriage for same-sex couples. For many, this marked the end of a decades long struggle to secure access to healthcare, the immigration status of a partner, family inheritance, parental rights, the right to visit a partner in the hospital, and more. The tragedy of the HIV/AIDS crisis had thrown into sharp relief what it meant to be deprived of these rights, and Obergefell was a moment of triumph and joy for the entire community. Then in 2022, the Supreme Court overturned Roe v. Wade and made it clear that Obergefell could be next, jeopardizing marriage equality for many.
The Policy
Here in Arizona, same-sex marriage is still illegal on paper. Between state statute and the state constitution, we actually have two separate bans. In Chapter 1 of Title 25 of the Arizona Revised Statutes (ARS 25-101), “marriage between persons of the same sex is void and prohibited.” Mirroring this, Article 30 of the Arizona Constitution reads (in entirety) “only a union of one man and one woman shall be valid or recognized as a marriage in this state.” It was a constitutional challenge to these definitions of marriage that ultimately won marriage equality in Arizona, with the 2014 district court ruling mentioned above, which means that even if Obergefell is overturned, those trigger bans won’t actually be triggered. Nonetheless, they remain a threat, and if more precedent is reconsidered, like the Supreme Court decision in Windsor, we may not be able to rely on the 2014 ruling for long.
The Solution
Removing the threat of ARS 25-101 part C and Article 30 would be relatively straightforward from a technical standpoint. With one bill, the legislature could update ARS 25-101 to cut part C, and with a resolution, they could invite voters to repeal and replace Article 30. Politically, it would be far from simple, but the technical simplicity of the solution highlights what is true of many societal problems — it is an active choice that maintains the injustice, and we can just as easily choose to undo it.
Criminal Justice
The Problem
There are two under-recognized ways Arizona’s criminal justice system fails LGBTQ+ people.
In our jails, trans and non-binary people are routinely held in isolation for extended periods of time, heightening the psychological trauma of an already traumatic experience.
In our prisons, LGBTQ+ people are routinely profiled for disciplinary ticketing on the basis of their identity or perceived gender non-conformity, jeopardizing their earned release credits and delaying their ability to return to their lives outside of prison.
The Policy
The first problem can be directly connected to a policy set by the Maricopa County Sheriff’s Office for “Transgender and Intersex Interactions,” which recommends isolating trans and non-binary individuals for their safety. The second problem is difficult to track down, because the Department of Corrections, unlike other state agencies, is exempt from the laws that require public transparency in rulemaking (ARS 41-1005).
The Solution
On the whole, the MCSO policy provides important guidance for understanding the needs and identities of transgender people, but it’s far from perfect, and needs updating to address the reality of what trans and non-binary people are experiencing in county jails. Without transparency, there can be no accountability, so the first step to address the policy failures of the Department of Corrections is to rescind their exemption from ordinary rulemaking procedures.
Housing
The Problem
According to U.S. Census Bureau data, LGBTQ+ adults, and particularly trans and non-binary people, face higher rates of housing insecurity than their straight or cisgender peers. Among LGBTQ+ youth, the Trevor Project found that 28% had experienced “homelessness or housing instability at some point in their lives.” We’re living through a housing crisis, and the LGBTQ+ community is particularly at risk.
The Policy
Many of the policies affecting housing affordability or the experience of being unhoused sit at the municipal level. Phoenix City Code defines a number of “offenses against public peace” that are used to criminalize homelessness and sex work; policies like these only further marginalize already marginalized people, putting them at even greater risk of sustained housing insecurity or homelessness. But the failures in this case extend beyond written policy, and the City of Phoenix is struggling in court to defend its conduct towards unhoused residents. When it comes to affordable housing, cities often have their hands tied by state level policy, as documented in depth by the Morrison Institute for Public Policy — notably, “Arizona is one of only seven states that prohibit local governments from enacting mandatory inclusionary zoning.”
The Solution
Decriminalizing homelessness, whether by taking offenses off the books or simply directing the police to deprioritize enforcement, is an important step in the right direction. At the state level, we need to lift preemptions against inclusionary zoning policies, and provide new guidance to municipalities for affordable development.
Privacy & Records
The Problem
Transitioning can involve many different steps, from using a new name or pronouns, to taking hormones or using surgical interventions, to changing your wardrobe, but these steps can look different for everyone. For many trans and non-binary people, it can be important to update your legal documents early in the process; having information on your driver’s license that doesn’t match who you are can be dangerous in the wrong situation, but it’s also just painful to have the wrong name called every time at the doctor’s office, and it can be incredibly affirming to see the name you chose and a new gender marker on your ID.
The problem is that it costs hundreds of dollars to obtain the court order necessary to update your name with the collection of agencies that keep track of our identities. If you don’t accomplish all of the steps in the right order, or you’re unable to update some of your documents, you could suddenly find yourself out of sync with the credit reporting agencies and automatic identity verification systems that can determine your ability to access housing. To avoid this, you’ll want to update social security, your state ID, your passport, and your birth certificate, all with your new name and gender marker. If you were born in Arizona, you may not be able to.
The Policy
The first policy problem we ran into was a filing fee for a court order. The Arizona Code of Judicial Administration is relevant here, but the minimum fee of $188 is actually set by state statute (ARS 12-284). County clerks then set the fee somewhere above that figure. In Maricopa County, the fee for a name change petition is $333. Changing your name and gender marker at the MVD is possible with that court order and a letter from a doctor, but the same policy doesn’t apply to Arizona birth certificates. To update the gender marker on a birth certificate, state law (ARS 36-337) and administrative code (AAC R9-19-208) require written proof of a “sex-change operation,” which may not be medically relevant for every person’s transition.
The Solution
Reducing filing fees would make it simpler for trans and nonbinary people to update their paperwork on the schedule that works best for them, and in a timeframe that avoids any major disruptions to credit reporting. Updating state law and administrative code to allow for self identification of gender on both state ID and state birth certificates would go even further.
Kids’ Rights
The Problem
According to the Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health, almost half of all LGBTQ+ kids in Arizona seriously considered suicide in the past year, with an even higher percentage reporting symptoms of depression and anxiety. Books with the stories of their lives are being removed from libraries while pointless new rules are created to make it harder to ask to be called by a new name or new pronouns that might make them feel more at ease in themselves and in their academic pursuits. For years, LGBTQ+ youth have been subjected to increasingly hostile public scrutiny over their identities, here in Arizona and across the country, and for many in other states this has escalated to the outright criminalization of any supportive adult in their lives. LGBTQ+ children are under attack.
The Policy
One of the main things that has made the anti-LGBTQ+ legislative movement possible is the legal reality that people under the age of 18 have very few rights. A cornerstone of the anti-LGBTQ+ movement has been to weaponize the idea of parental rights against self expression, self determination, and other basic human needs, like access to healthcare and information. Restrictions on gender-affirming care or LGBTQ-inclusive sex education are able to find success because many people are already accustomed to treating people under the age of 18 as extensions of their parents (or, less generously, as property). Dangerous and damaging practices like “conversion therapy” that attempt to punish and recondition LGBTQ+ or gender-nonconforming children are allowed to continue despite whatever reservations many might feel, because while they may not choose it for their own children, they’re still criticizing it as a choice for a parent to make. The agency of children is completely abstracted away.
The Solution
The solution is simple, but manifold. In a near vacuum of legal rights, kids need policy that affirms their agency and decision-making power. We need to start by banning the abuse known as conversion therapy and by repealing laws (like those introduced in 2022 with SB 1138 and SB 1165) that limit access to healthcare, school facilities, or academic opportunity on the basis of identity. Free access to information, including age-appropriate, LGBTQ-inclusive sex education should be protected as a right. Proactive legislation should be put in place to ensure that people under the age of 18 have the option to consent to essential healthcare services, and a right to confidentiality in those cases. School boards have a place for student voices in the decision-making process, and student board members should be able to expect a real vote. For most Arizonans, we’re able to quickly and easily register to vote when we get a driver’s license; so why not make that an option for everyone, and lower the voting age to 16? School choice is an important policy to allow parents to provide incredible alternative educations for their kids, but why not provide school choice for students too, with a right to opt-in to public education? If we lost you halfway through this paragraph, that’s okay, but take a minute to go back and think about exactly where and exactly why.