The Centers for Medicare & Medicaid Services, or CMS, approved Colorado’s request to provide gender-confirming care as part of the state’s “essential health benefits,” which are requirements for individual and small employer plans set forth under former President Barack Obama’s Affordable Care Act. Federal law does not require states provide coverage for gender-confirming care in their state Medicaid programs, allowing state policies to range from banning all forms of gender-affirming care to not having a written policy on this type of coverage. This leaves thousands of transgender adults on Medicaid without coverage and causes a “gray area” where individuals have to navigate the plans with their health care providers, said Christy Mallory, legal director at the Williams Institute, a research institute based in the University of California Los Angeles’ School of Law.
The state’s plan under the Centers for Medicare & Medicaid Services will include jaw, cheek and eye modifications, face tightening, facial bone remodeling for facial feminization, breast or chest construction and reductions and laser hair removal. Additional health benefits for Colorado’s plan include an annual mental health exam and expanded coverage of opioid alternatives for pain management, Democratic Gov. Jared Polis said. The new plan adds 15 drugs as alternatives and will cover up to six acupuncture visits per year, according to the Colorado Division of Insurance. The changes will go into effect Jan. 1, 2023. Mallory said that without insurance, much of gender confirming care is “prohibitively expensive,” and including these services in insurance plans increases access to medically necessary care for trans people.
“People who need access to this care will not only be healthier because they are getting the care they need through a doctor, through a licensed health care provider, but also that that will have positive impacts on their health overall … as a result of being able to transition and be their full selves,” Mallory said. CMS guidelines allow for states to submit their own coverage requirements but stipulate that they include certain categories such as preventive and wellness services, chronic disease management, maternity and newborn care, hospitalization, prescription drugs, treatment for mental health and substance use disorders, behavioral health, and lab services.
Coronavirus pandemicTexas order reflects growing GOP vaccine mandates hostilityFlorida fines key county $3.5 million for mandating vaccinesNext on FDA’s agenda: Booster shots of Moderna, J&J vaccinesRussia hits new record for COVID-19 deaths, resists lockdownADVERTISEMENT “States can be incredibly interested in what other states do,” Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure said at a news conference Tuesday. “I think that Colorado making this step of going forward and affirming this desire will cause other states to also take a look at their coverage and think about whether to add gender-affirming coverage as well.” The announcement comes as Republican-led states have enacted several restrictions on transgender people’s rights this year. Arkansas became the first state to ban gender confirming treatments or surgery for transgender youth. West Virginia was among several states that approved restrictions on transgender athletes. The Department of Justice ruled in June that the laws in both states violate the equal protection clause of the 14th Amendment.
In June, two transgender women sued the state of Georgia, saying that they had been denied access to gender-affirming health care under the state’s Medicaid program. Twelve states exclude gender-affirming care in Medicaid coverage and 20 states have not addressed it, according to the Williams Institute. Gender-affirming care is considered a standard level of care by the American Medical Association, the American Academy of Family Physicians, and the American Psychiatric Association, the federal health department said in a release.
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