NY25-10: Incongruent Identity Documents (IIDs) Among Transgender and Nonbinary Populations and Structural Implications for Access to Social Security Benefits, Disability Insurance and Healthcare

This cross-sectional study uses mixed methods to explore the impact of incongruence in official identity documents for transgender and nonbinary (TGNB) people. Social security and disability benefits, Medicare/Medicaid coverage, and many bureaucratic processes rely on a range of identity documents that can be a significant barrier to access for many different vulnerable groups. Documents that can be used to prove a person’s identity are identity documents; examples include driver’s license, social security card, and birth certificate. Incongruent Identity Documents (IIDs) refer to problems in accuracy for such documents in terms of name and gender marker. This study will investigate how gender incongruence in identity documents functions in bureaucracies and influences social determinants of health for TGNB people. Using mixed methods, the study objectives are as follows: (1) Identify the impact of IIDs on accessing social security benefits for TGNB individuals with long-term disability and/or aged 55 and older; (2) Examine associations between IIDs and access to health insurance under Medicare and/or Medicaid; and (3) Develop recommendations for improving access for TGNB people to social security and disability benefits through focus group discussions.

Significance: Multiple studies examining IIDs among TGNB populations have found that legal name change policies are structurally important in addressing social determinants of health including housing, employment, and health insurance coverage. This study bridges an important gap in both knowledge and policy advocacy related to structural blind spots unique to TGNB people and the impact of IIDs in navigating social security and disability benefits.

TGNB people of color and those with lower household incomes and education are less likely to seek updated records [2]. Studies have also shown that those presenting IDs that do not match their gender presentation experience significantly increased odds of harassment in housing, employment and health care. TGNB elders are more likely to experience poorer health outcomes than the general elder population. According to the US Transgender Survey, 39% of respondents reported a disability compared to 15% of the US population. Similarly, 30% of respondents to the National Transgender Discrimination Survey (compared to 5% of the general US population), reported significant difficulty concentrating, remembering or making decisions due to a physical, mental or emotional condition. Despite the indication of multiple vulnerabilities, empirical research is limited for TGNB elders and disabled people. The proportion of TGNB elders is expected to rise in the coming years, including disabled TGNB elders. The well-documented institutional biases that TGNB people face signal barriers to accessing available social benefits, which may include social security, disability benefits, and government health insurance programs for which individuals may be eligible due to disability (Medicare and Medicaid), age-based criteria (Medicare) and/or low income (Medicaid).