Background: Research has found that those who are LGBTQ+ face disproportionate mental health outcomes with transgender and gender diverse (TGD) individuals having even greater mental health disparities than the general population and cisgender LGB+ individuals alike. Cross-sectional and surveillance studies have also found that LGBTQ+ and TGD individuals disproportionately have health access-related disparities in terms of healthcare coverage and perceived barriers to care than the general population. There is indication that LGBTQ+ individuals in the U.S. South have greater and unique health needs due to a widening health coverage gap relative to other regions of the U.S. Aim: Using 2017 LGBT Institute Southern Survey data, this study examines the relationships and disparities in mental health among LGBTQ+ individuals and across sexual and gender identity groups with healthcare coverage and perceived barriers to care to address multiple research gaps in LGBTQ+ and trans health research. Methods: A chi-square analysis was conducted to determine associations and group differences in healthcare coverage with psychological distress. Several One-way ANOVA tests were performed to assess the mental health disparities between sexual, gender and racial/ethnic groups via the mean psychological distress scores. Lastly, multivariate linear regression models were used to investigate the relationships healthcare coverage, perceived barriers to care, and individual LGBTQ+ identities have with psychological distress, after inputting sets of socio-demographic variables and interaction terms into each model. Results: There were disparities in healthcare coverage and mean psychological distress scores between LGBTQ+ groups, with higher uninsured rates and mean distress for respondents identifying as bisexual or other and among those identifying as TGD. In the linear regression, healthcare coverage (p<0.0001) and perceived barriers to care (p<0.0001) were significantly associated with psychological distress, even after all socio-demographic variables were controlled. Trans women (β=1.44, p<0.01) and gender diverse individuals (β =1.05, p<0.05) compared to cis men, and bisexuals (β=0.93, p<0.01) compared to gay men have higher distress. Conclusions: Mental health and health access disparities within LGBTQ+ sub-groups exist, which future studies should further examine utilizing inclusive, robust study designs. Public health policies and interventions which promote cultural responsiveness would be beneficial in reducing health access disparities among LGBTQ+ Southerners associated with poorer mental health statuses.