In a significant decision by state and federal officials, many private health plans sold in Colorado will soon be required to cover hormone therapy, genital reconstruction services and other procedures sought by transgender patients.
The change, which will take effect on January 1, 2023, marks the first time the federal government has approved a requirement for infection-related coverage in individual and small-group health plans. More than a dozen states, including Colorado, already include such services in their Medicaid plans.
Biden officials cited discrimination against transgender patients and predicted that Colorado’s decision would serve as a road map for other states to broaden such coverage. He also said the approval helps fulfill the president’s campaign pledge to expand access to coverage for LGBTQ Americans, by requiring insurers to cover infection-related care.
“Colorado is taking a very important step,” Health and Human Services Secretary Javier Becerra said in an interview. “transgender” [people] There is constant discrimination. And this is accelerated in part by transgender Americans’ inability to access essential health care services.”
Tuesday’s announcement is also the latest in a series of decisions from the Biden administration to codify policies sought by LGBTQ Americans, including a May 2021 announcement to broaden anti-discrimination protections for transgender patients. The Trump administration limited access to those protections.
Colorado Gov. Jared Polis, D, Medicare and Medicaid Services Administrator Chiquita Brooks-Lasur and other officials announced the policy in Denver. The new coverage for infection-related procedures, which was authorized under a Trump-era policy that allows states to request amendments to their health insurance markets governed by the Affordable Care Act, requires Colorado health plans to “Gender-affirming care” will need to be provided. Guaranteeing essential benefits to your customers.
“We hope this is a historic start, and other states look to Colorado as a model,” Brooks-Lasur said. “We invite other states to follow suit.”
Some transgender patients described the challenges of accessing expensive services such as hormone therapy, saying that interruptions or delays in care could result in long-lasting setbacks in their transition. A November 2020 study by Out2Enroll, an organization that helps the LGBTQ community obtain health insurance, found that most plans sold through the government’s health insurance website HealthCare.gov failed to specify whether they were intended for transgender patients. Covers care. Out2Enroll found that in 7 percent of cases, health plans did not explicitly cover procedures for transgender patients.
According to LGBTQ advocacy organization One Colorado, many private health plans in Colorado already cover transition-related procedures such as hormone therapy. But officials in states led by Republican governors such as Arkansas and Texas have limited access to care to those with infections.
Katie Keith, an attorney and co-founder of Out2Enroll, said transgender patients in every state should be able to afford the care they need under a provision of the Affordable Care Act, barring discrimination. Yet, they often face denial or rejection because health plan policies are not always clear about what they do or don’t do.
“Significant progress has been made, but we’ve seen exclusion by some health plans — it worsened under the Trump administration — and that’s why it’s important for states like Colorado to take steps to fill those gaps,” Keith said. .
Under Tuesday’s announcement, treatments such as facial bone remodeling for facial feminization, breast creation and reduction, and laser hair removal will also be considered essential health benefits in Colorado. Brooks-Lasur and other officials called the procedures “lifesaving,” citing evidence that helping transgender patients transition can reduce their risk of suicide and promote other health outcomes.
“I know from personal experience, how important it is to be safe, comfortable, and heard by providers who help us manage the most intimate and sometimes most painful healthcare needs,” Colorado Lt. Gov. Diane Primavera Said, d. “As a state, we want to support patients and providers as we build a more inclusive and affirming health care system.”
Conservative advocacy groups oppose President Joe Biden’s efforts to expand services to transgender Americans, arguing that the evidence is not settled on the need for such policies. “Biden’s HHS chooses ideology over science on transgender issues,” Roger Severino, a Trump appointee who served as the health department’s civil rights chief, wrote in a May 2021 Newsweek op-ed that Biden Previously revived the government’s anti-bias protections for transgender patients. this year.
The American Medical Association, the American Psychiatric Association and other medical groups have called on health care organizations to expand protection and care for transgender patients.
“Gender-affirming care is medically necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people,” AMA board member Michael Sook said in a June 2021 statement.
Separately, the federal government also authorized Colorado’s requests to include mental wellness exams and acupuncture for chronic pain as essential benefits.