Under a groundbreaking decision by state and federal officials, many private health plans sold in Colorado will soon be required to cover hormone therapy, genital reconstructive services and other procedures sought by transgender patients.
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The change, which would take effect on Jan. 1, 2023, would mark the first time the federal government has approved a requirement for transition-related coverage in individual and small-group health plans. More than a dozen states, including Colorado, already cover such services in their Medicaid plans.
Biden officials cited discrimination facing transgender patients and predicted the Colorado decision would serve as a road map for other states seeking to broaden such coverage. They also said the approval helps fulfill the president’s campaign pledge to expand access to coverage for LGBTQ Americans, including requiring insurers to cover care related to transitions.
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“Colorado’s taking a very important step,” said Health and Human Services Secretary Xavier Becerra. “Transgender [people] face discrimination on a constant basis. And it is, to some degree, intensified by the inability for transgender Americans to get the health care services they need.”
Tuesday’s announcement also is the latest in a series of Biden administration decisions to codify policies sought by LGBTQ Americans, including a May 2021 announcement to broaden anti-discrimination protections for transgender patients. The Trump administration narrowed access to those protections.
Colorado Gov. Jared Polis (D), Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure and other officials are set to make the announcement in Denver on Tuesday. The new coverage for transition-related procedures, which was authorized under a Trump-era policy that allows states to request modifications to their health insurance markets governed by the Affordable Care Act, would require Colorado health plans to provide “gender-affirming care” among the essential benefits guaranteed to their customers.
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Some transgender patients have detailed their challenges obtaining costly services like hormone therapy, warning that interruptions or delays in care can lead to long-lasting setbacks in their transitions. 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 covered care for transgender patients. In 7 percent of cases, health plans explicitly excluded procedures for transgender patients, Out2Enroll found.
Many private health plans in Colorado already tend to cover transition-related procedures like hormone therapy, according to One Colorado, an LGBTQ advocacy organization. But officials in states led by Republican governors, like Arkansas and Texas, have moved to limit access to care for people seeking to transition.
[Biden administration revives anti-bias protections in health care for transgender people]
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The federal health department “recognizes that expanded, gender-affirming coverage vastly improves health-care outcomes for the LGBTQ+ community, reduces high rates of depression, anxiety, and suicide attempts as well as decreases substance use, improves HIV medication adherence, and reduces rates of harmful self-prescribed hormone use,” CMS said in a statement Tuesday.
Conservative advocacy groups have repeatedly targeted Biden’s efforts to expand services for transgender Americans, arguing the evidence on the need for such policies is not settled. “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 Newsweek op-ed after Biden revived the government’s anti-bias protections for transgender patients earlier this year.
The American Medical Association, the American Psychiatric Association and other medical groups have called for health care organizations to institute protections and expand 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,” Michael Suk, an AMA board member, said in a June 2021 statement.