Massachusetts once again landed at the head of the pack in an annual ranking of state protections for lesbian, gay, bisexual, transgender and queer people, joining 15 other states atop the scorecard after a year in which voters preserved a transgender anti-discrimination law while other LGBTQ-related bills failed to become law.

The Human Rights Campaign Foundation and the Equality Federation Institute on Monday released their 2018 State Equality Index, an annual report on state laws affecting LGBTQ people and their families.

This marks the third year in a row Massachusetts has received the scorecard’s highest ranking, “Working toward innovative equality.” Sixteen states and Washington, D.C. earned the rating in 2018, up from 13 in 2017.

In the 2018 rankings, four states — Hawaii, Iowa, Maryland and New Hampshire — were placed in the second-tier category “Solidifying equality,” and Utah and Wisconsin landed in the third tier, “Building equality.” The remaining 28 states hit the bottom rung, which the HRC calls “High priority to achieve basic equality.”

Human Rights Campaign President Chad Griffin said “dozens of anti-LGBTQ bills” were defeated last year, and that advocates see the promise of additional equality protections passing into law in 2019, pointing to recent action in New York, Virginia, Kansas, Ohio, Michigan and Wisconsin.

“However, LGBTQ people still face the sobering reality that their rights are determined by which side of a state or city line they call home,” Griffin said, calling for passage of a federal non-discrimination bill known as the Equality Act.

In 2016, Gov. Charlie Baker signed a law banning discrimination based on gender identity in public accommodations. Voters last year beat back a repeal effort, with 68 percent in favor of keeping the law and 32 percent for scrapping it.

“Massachusetts has long been considered a leader in LGBTQ rights, but we still have work to do before everyone in the Commonwealth enjoys full equality,” MassEquality executive director Deborah Shields said in a statement. “Massachusetts made history last year by defeating a statewide ballot measure that would have repealed our law protecting transgender people from discrimination, and we will be working hard to build on that victory this year by passing laws to ban the use of conversion therapy on minors, ensure young people receive accurate and comprehensive sex education, add a third gender marker to state-issued ID documents, and more.”

According to the HRC, a record five states passed laws prohibiting the practice known as conversion therapy during the last legislative session, bringing the total number of states with such bans on the books to 15.

In Massachusetts, the House in June 2018 voted 137-14 to ban the use of conversion therapy to change the sexual orientation and gender identity of minors. On July 31, the final day of formal legislative sessions for the year, the Senate passed its own conversion therapy ban bill, but lawmakers never reconciled the two bills.

Rep. Kay Khan of Newton has refiled the bill in the House this session, and posted to Twitter over the weekend that 116 lawmakers had signed on as cosponsors. Sen. Mark Montigny of New Bedford has filed a Senate version.

Also in June, the Senate passed a bill that would allow Massachusetts residents to select the non-binary gender option of “X” on their driver’s licenses. A priority of Senate President Karen Spilka, the bill never reached the House floor for a vote.

Sen. Jo Comerford and Rep. David Linsky each filed versions of the “gender X” bill this session.