The Biden administration has approved a request by Colorado officials to modify their state’s health exchange under the Affordable Care Act to require private health insurers to cover transition-related care for transgender patients.
The change, which will take effect on Jan. 1, 2023, would mark the first time the federal government has approved a requirement for individual and small-group health plans to cover medical treatments for transgender patients. Colorado already requires its state Medicaid program to cover the costs of transition-related care for low-income residents.
Colorado Gov. Jared Polis, accompanied by Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, and other officials, announced the policy in Denver last week. Under the new policy, insurers will no longer be able to refuse to cover treatments that have been deemed medically necessary by a patient’s medical provider by claiming such procedures are “elective” or “cosmetic.”
“We hope this marks a historic beginning, and that other states look to Colorado as a model,” Brooks-LaSure said in remarks. “We invite other states to follow suit.”
The approved change only applies to small-group or individual plans, meaning the state legislature would need to act in order to require large employers’ insurance plans or government programs like Medicare.
Biden administration officials noted that transgender patients can often experience discrimination when seeking out transition-related treatments for gender dysphoria, and predicted that Colorado would serve as a model for other states that wish to ensure such treatments are considered essential benefits by insurers.
Among the treatments that will now be covered include hormone therapy, eye and lid modifications, face tightening, facial feminization procedures, breast/chest construction and reductions, and laser hair removal.
According to The Washington Post, many private insurers in Colorado already cover transition-related procedures, but other states have moved to limit access to care for transgender people, particularly when it comes to transgender youth seeking out hormones or puberty blockers.
“Colorado’s taking a very important step,” Health and Human Services Secretary Xavier Becerra told the Post in an interview. “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.”
By approving Colorado’s request, President Biden has taken yet another action building upon a May 2021 announcement reviving Obama-era protections against discrimination in health care based on a patient’s gender identity or sexual orientation. Those protections had previously been rolled back by the Trump administration, which argued that the Affordable Care Act’s nondiscrimination provisions prohibiting sex-based discrimination should not be applied to instances where patients are discriminated against based on their LGBTQ status.
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. A study by the Columbia University Department of Psychiatry found that transgender individuals who have received gender-affirming care have lower rates of depression, and are less likely to report thoughts of suicide than those who were denied care.
“Based on our own research, we know that gender-affirming care is vital to the mental health of transgender and nonbinary Coloradans,” Marvyn Allen, the health equity and training director for the LGBTQ rights organization One Colorado, said in a statement. “For too many, gender-affirming care is unaffordable and unattainable. … We advocated for [this] plan because we knew the improvements to the health and wellness for transgender Coloradans would be immense, and saw in the research that including gender-affirming care would not have significant impacts on insurance rates for Coloradans.”
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