Medicaid is an important program that provides health coverage for millions with low incomes, including LGTBQ+ individuals. Medicaid covers a wide area of health services, including gender-affirming treatments for transgender, nonbinary, and gender nonconforming people. The World Professional Association for Transgender Health (WPATH) recognizes that transgender, nonbinary and nonconforming individuals experiencing gender dysphoria and should be provided various medical options to alleviate that stress. Under the standard of care provisions, treatment should reflect the needs of the individual and with guidelines established through WPATH.
Gender-affirming health care interventions include mental health services, surgical procedures, and a range of other services. Those services can include hormone replacement therapy, hair removal (electrolysis) voice therapy, and surgeries such as chest augmentation or reduction, vaginoplasty, hysterectomy, and more. Under federal law all states must cover these gender-affirming services however some states do not follow federal guidelines such as South Carolina, Tennessee, Texas, Arizona, Nebraska, Florida, and Missouri.
Even with Medicaid coverage transgender, nonbinary, and gender nonconforming people still face barriers for care. Many individuals experience stigma, discrimination, and mistreatments from their health providers. These barriers are especially evident for people of color and immigrants, who live at poverty level. Some surgeons and insurers do not provide or cover certain procedures without multiple letters or referrals from mental health professionals. This can cause barriers to receiving care as those seeking treatment jump through hoops getting letters and booking appointments with mental health professionals. Furthermore, those in rural areas have few or no gender-affirming care options. Additionally, providers in rural areas may not use inclusive language and can create negative experiences for those looking for life saving medical care.
All state Medicaid programs are bound by nondiscrtimination laws. These include Section 1557 of the Affordable Care Act, which prohibits health programs and activities receiving federal assistance from discrimination on the basis of race, ethnicity, national origin, age, disability and sex. Section 1557 is the first-ever federal ban on sex discrimination in health care. You may be asking yourself: What can I do to promote gender-affirming care in Medicaid? First you can submit a comment opposing the June 24, 2019 changes to the ACA Section 1557 final rule. Visit regulations.gov to review the proposed rule and submit your comment letter. And if you live in a state that has an exclusion on gender-affirming care or does not explicitly state Medicaid coverage of gender-affirming care, advocate with your state Medicaid agency to remove those exclusions.