Fact check: What are the most trans-friendly states in the USA?

1. Why some states emerge as top choices — laws and lived access

States repeatedly identified as among the best for LGBTQ+ and transgender residents score highly because they combine nondiscrimination statutes, healthcare access, and supportive family and education policies, which together create practical safety and access. Analyses listing the 15 best states for LGBTQ+ residents name California, Massachusetts, New York, Oregon, Washington, Minnesota, Vermont, and similar states where marriage, family rights, health care access, and education protections are robust ^[1]. Movement-level data confirm that national coverage is mixed: about half of the LGBTQ population lives in states with statutory protections against housing and public-accommodation discrimination based on gender identity, indicating those states are comparatively more trans-friendly ^[2].

2. The healthcare divide: shields, bans, and the geographic split

Healthcare access is a decisive factor for trans-friendliness. Movement Advancement Project data show only 38% of transgender people live in states with “shield” laws protecting access to gender-affirming care, 6% under shield executive orders, and a majority live without such explicit protections ^[3]. Simultaneously, a notable portion of states enacted bans on best-practice medical care for transgender youth: analyses report 38% of transgender youth live in states that ban medication or surgeries, leaving 60% in states without such bans — a split that materially affects whether a state is functionally trans-friendly ^[4].

3. Legislative storms: why rankings can change quickly

The ACLU and Movement Advancement Project materials document an intense legislative cycle in 2025 with a record number of bills aimed at restricting transgender rights, especially targeting youth and local nondiscrimination authority ^{[5] [6]}. That legislative activity means states once considered safe can see protections erode rapidly, and the policy landscape shifts within months. The dynamic explains why lists of “best states” are snapshots: statutes, executive orders, and court decisions interact, so a state’s ranking depends on the date of assessment and which protections (healthcare vs. housing vs. education) are weighted most heavily ^{[7] [5]}.

4. Policy bundles matter: nondiscrimination plus healthcare plus enforcement

Being “trans-friendly” requires more than one protective law. Movement-level reporting highlights that nondiscrimination statutes alone do not guarantee access unless paired with Medicaid coverage, private insurer mandates, and enforcement mechanisms; about 49% of LGBTQ people live in states that prohibit housing discrimination based on sexual orientation and gender identity, and 48% in states prohibiting public-accommodation discrimination, but gaps in healthcare and regulatory protections persist ^[2]. The most supportive states combine statutes, Medicaid/insurance coverage, and local authority to defend rights, producing tangible outcomes beyond symbolic protections ^{[1] [3]}.

5. Where the metrics disagree and what they omit

Different reports measure different things: rankings that create top-15 lists emphasize quality of life indices—marriage, family law, education and healthcare—while maps from the Movement Advancement Project focus on specific legal protections or bans, like Medicaid coverage or youth-care prohibitions ^{[1] [7]}. This leads to apparent contradictions: a state might rank high in general LGBTQ quality-of-life but still host limits on specific transgender care or lack enforcement resources. Analyses often omit lived-experience metrics such as local provider availability, community safety, or the degree of practical enforcement—factors that materially shape trans-friendliness ^{[2] [3]}.

6. Interpreting the data: percentages, populations, and practical meaning

Population-weighted figures show why some protections matter more: Movement Advancement Project reporting notes 72% of transgender people live in states that do not explicitly regulate gender across state law to allow discrimination, which superficially sounds protective but does not assure comprehensive, enforceable rights ^[8]. Similarly, while 38% live in states with shield laws for healthcare, that leaves a majority without legal safety nets ^[3]. Therefore, the practical conclusion is trans-friendliness is partial and uneven, concentrated in states with layered legal protections and eroded in others experiencing active legislative attacks ^{[5] [4]}.

7. What to watch next — legal fights and policy indicators

Going forward, the most important indicators of whether a state remains trans-friendly are legislative activity on youth-care bans, expansions or rollbacks of nondiscrimination law, Medicaid and insurer coverage decisions, and state-level “shield” protections for healthcare access. The ACLU’s ongoing mapping of 2025 legislative activity and the Movement Advancement Project’s updates provide near-term signals of change; tracking these items by date reveals where protections are strengthening or weakening ^{[5] [7]}. For now, states consistently named in favorable lists offer comparatively better legal frameworks, but the landscape remains volatile and requires continual monitoring ^{[1] [2]}.