Between January and May, 2022, there have been more than 200 anti-LGBTQIA+ bills filed across the United States, with the majority of the bills targeting trans and non-binary people. The legislation ranges from restrictions on sports participation and bathroom use, to receiving gender-affirming health care. Gender affirming health care is a lifesaving intervention that is protective for the mental and physical wellbeing of trans, non-binary, and gender expansive people. It celebrates diversity in gender identity, and supports people in exploring, defining, and feeling alignment in their gender expression and identity. All major health organizations agree that early access to gender affirming care is the safest for the overall wellbeing of people, but regardless of age, access can be limited by where a person lives and the political views of their community. Virtual care has served as a safe haven for people to access the care they need from the privacy of their safe place. At Womanly, we believe in health care for all, and we know that the LGBTQIA+ community has the right to receive the care that they need in a way that is dignified and respects their whole personhood. FOLX Health is a leader in providing care specifically for the LGBTQIA+ community and boldly advocating for equity to protect the rights of LGBTQIA+ people across America.
Our Senior Health Educator, Terri Fleming MSN, APRN, FNP-BC, AAHIVS (she/her), spoke to FOLX Health’s Chief Clinical Officer about their innovative virtual care model and expanding care for queer and trans folx across the United States.
Kate Steinle MSN, WHNP-BC (she/her) has been a Nurse Practioner, providing sexual and reproductive health care, for more than a decade. She believes health care can be a place of radical transformation and empowerment, for both those who access care and for the providers.
“Instead of health care being about sickness, we’re creating affirming spaces where our members can experience joy.”
Terri Fleming: Tell me a little bit about starting FOLX and what you all currently offer?
Kate Steinle: Our founder has been a disruptor in the health care field for a long time and feels strongly about re-envisioning health care as an avenue for empowerment. Instead of health care being about sickness, we’re creating affirming spaces where our members can experience joy. We also want to create health care that centers the LGBTQIA+ community and prioritizes accessibility. We want people to see themselves represented in every single part of what we do versus feeling like they are an afterthought or an add on. What we are creating right now is beneficial to the queer and trans community but we also believe this type of empowering health care can be created for anyone.
Terri Fleming : As far as your services, can you just tell us about what you offer? I know y'all are expanding fast.
Kate Steinle: A lot of our current focus and most of our memberships are for trans and gender non-binary affirming hormone care. That's like 97% of what we do right now. In the fall we launched virtual care, what we call ‘light primary care,’ which are open consultations to talk with a clinician about anything that comes up. We’ve been building out our referral network for situations where people need in-person care, and we're working to create a training program that will allow healthcare clinics and providers to receive training and become FOLX approved.
We will soon be launching expert-led support groups and peer support groups. All of the topics of those groups will be based on what we hear from the community and what their needs are. This could include eating disorders, parental support for trans kids, coming out as trans at school or at work, how to be financially healthy, or second parent adoption for people who are going through family-building.
Terri Fleming: I love that, because it’s such a unique platform, you're able to build and add based on what the community needs. Can you tell me a little bit more about your decision to bring on queer and trans providers?
Kate Steinle: Most of the providers we have right now and most of the employees who work at FOLX are part of the LGBTQIA+ community. What this offers is not only the understanding of community needs, but also the passion to support the community and the expertise to do so. You definitely don’t have to be trans or queer to work here. However, you do have to be an expert in interacting with and caring for this community. As a clinician, you have to be able to offer an empowering and affirming experience for members, which means you can't just have read an article about how to provide affirming care or just had one lecture in med school or nursing school about how to care for the LGBTQIA+ community. Providers need to have deep experience engaging with members of this community because there's different ways to talk about things and different terminology.
I can train anyone on medical protocols, but it takes years of experience and commitment to this community to create in-depth knowledge and connection. I want clinicians who believe in empowering care and believe in person-centered care where they are not a leader but a partner. That's a key piece in terms of how we're doing this model of care—to really listen and connect with members’ experiences. The opposite of that is what a lot of people in this community have experienced when they go to their providers and intake forms don't even recognize their identity, the type of sex they're having, or who they're having sex with. So what we try to create is this safe space for people to be able to express who they are and what is going on for them.
Terri Fleming: Are there any initiatives for people with financial barriers? Does FOLX take Medicaid or Medicare?
Kate Steinle: At this time we offer a membership based model. Monthly membership costs include unlimited clinical time, cost of labs, and medications delivered to your door. We do not yet accept insurance to cover membership fees but if somebody wants to use their insurance to cover their medication cost at a local pharmacy, we are able to do that.
We also accept FSA or HSA cards to pay for membership. We do have an HRT Care Fund, which raised a quarter of a million dollars last year and covered the cost of membership (including labs and medications) for recipients of the fund. We [partnered with] TransLifeline and a large percentage of the fund was reserved for BIPOC people in the community. I believe it was a total of about 100 people that we were able to provide free care for with that fund. This year we actually have a new partner, [The Black Trans Advocacy Coalition], and we're hoping the fund will be able to cover even more recipients this year. This year we are also moving towards being able to accept insurance.
Terri Fleming: What are some of the challenges, especially in this political climate, that you’ve faced as Chief Clinical Officer?
Kate Steinle: I was working in abortion care before coming to FOLX and the reality is that it's the same people who are trying to limit access to abortion care who are trying to limit access to trans care. It's a challenge as well as one of the things that motivates us because we're like, ‘okay, let's just keep spreading, let's keep getting out there.’ It's also a unique experience to work in a company that is made up mostly of trans and queer people and to experience both the passion and the struggle that brings.
Terri Fleming: What are some of your hopes and dreams for people seeking care in the community?
Kate Steinle: My hope is that FOLX really does help change the face of what health care can be. I hope we can show people that there's so much benefit in creating this kind of partnership between clinician and member, and by doing so, creating this joyful and empowering experience. I also hope that we can use our size and power to push clinical research forward. I want us to be a complete platform where clinicians, community members, and other health care organizations can find resources and get clinically accurate information to connect with people and experience healthcare in an entirely new way.
Terri Fleming: And finally, how do you take care?
Kate Steinle: I have three smallish kids and we're reading through the whole Harry Potter series. So cuddling up in bed and reading with them. It feels like I can just put aside all the big stuff and just experience the characters with them. And then the other thing that is my biggest joy is my home in Vermont that's been in my family for five generations. Now that I work in telehealth, I can spend most of my summer up there. It's a place where I can just be outside in between meetings, and I'm centered, because it's where my heart lives. So it feels nice to be able to be there on a more regular basis.
