Officials Tell Insurers To Stop Denying Coverage for Transgender Patients
California officials have told some health insurers to stop denying transgender patients coverage for certain treatments, the AP/Sacramento Bee reports.
Oregon regulators have issued similar instructions.
Advocacy groups say that transgender patients often are denied coverage for medical procedures unrelated to a gender transition.
In addition, some transgender patients struggle to obtain coverage for gender-specific care, such as an individual identifying as a man who seeks ovarian cancer screening or a hysterectomy.
Details of State Actions
California and Oregon are not requiring insurers to cover specific medical treatments for transgender patients. Instead, officials are telling certain private insurers to pay for medical procedures deemed medically necessary if they cover such procedures for patients who are not transgender.
According to the AP/Bee, such treatments could include:
- Breast reductions;
- Cancer screenings; or
- Hormone therapy.
The changes in California -- which took effect in September 2012 -- are clarifications of state anti-discrimination laws passed in 2005, rather than new policies, according to officials.
The changes apply to insurers covering about 7% of state residents through plans regulated by the state Department of Insurance, such as PPOs, but they do not affect Medicare or Medi-Cal beneficiaries or the majority of residents who are insured through an HMO. Medi-Cal is California's Medicaid program.
Marta Bortner Green -- a spokesperson for the California Department of Managed Health Care, which regulates HMOs -- said the agency has discussed transgender care with consumer groups and health plans, "but no regulations have yet been proposed or adopted."
Response From Advocacy Groups
Advocacy groups said the changes will help ensure equal access to health insurance benefits for transgender individuals.
Masen Davis -- director of the Transgender Law Center in San Francisco -- said that he is not aware of any states besides California and Oregon that are taking similar actions (Cooper, AP/Sacramento Bee, 1/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.