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Senate passes bill requiring comprehensive trans Medicaid coverage

Transgender_Pride_Flag_(37827573944).jpeg
Foreign and Commonwealth Office
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The Transgender Pride Flag flies on the Foreign Office building in London on Transgender Day of Remembrance, 20 November 2017

Under Maryland Medicaid rules, trans, intersex, and gender-diverse people can’t receive certain medically necessary, gender-affirming care. A bill the Senate passed Monday would change that.

The Trans Health Equity Act of 2022 would add Maryland to the list of many states, including California, Montana, and Wisconsin, that have expanded the gender-affirming care covered by their Medicaid programs in the past five years.

It would require the state’s Medicaid program to provide comprehensive gender-affirming treatment to the adults it covers.

Sen. Mary Washington, the Baltimore Democrat and lead sponsor, said the bill defines gender-affirming treatment.

“It affirms the treatment as being medically necessary, and it ensures that the treatment that is covered treats a condition that's related to the individual's gender identity.”

Dr. Elyse Pine, an endocrinologist at Chase Brexton Health in Columbia, told House and Senate committees she has treated thousands of gender-diverse patients over the last decade and has seen firsthand how important the care is.

“All major medical organizations agree that this care is medically necessary; the low-income Maryland transgender community deserves this lifesaving care.”

The state’s Medicaid program does cover some gender-affirming care, but it is not up to modern standards, Pine said. Some surgeries, voice therapy, and hair removal are a few of the treatments explicitly denied.

“The current Maryland policy has a long list of exclusions,” she said. “One set of exclusions is for facial procedures. Facial features, such as jawline and Adam's Apple are associated with a specific gender.”

Pine said an appearance that does not align with a person's outward gender expression causes tremendous internal distress and poses a great risk to their safety.

Margo Quinlan, of TransMaryland, said she was able to obtain some of these services through private insurance. But she knows they are inaccessible for lower-income people.

“These are the things that for a lot of trans people, for myself, in particular, this has been incredibly helpful for me too, you know, feel more comfortable to reduce my dysphoria and discomfort, but also to increase safety out in the world,” Quinlan said.

“These are things that are not only medically necessary, but they're life-saving for a lot of us. And these are the services that are currently being denied.”

Danny Mendoza, a public benefits and insurance navigator with Whitman Walker Health, says they have had to tell people they can’t begin or can no longer get the care they need because of a lack of, or change, in insurance coverage.

“It's just really hard telling someone that you're not able to get the care that you need because your insurance won't cover it,” he said. “Even for folks who had health insurance that was covering it before, and now being on a plan that won't cover it, it's such a big shock.”

Most often, Mendoza told WYPR, this happens to people experiencing homelessness, of which the trans community is at much higher risk.

The National Center for Transgender Equality reports one in five trans people will experience homelessness at some point.

Legislative analysts estimate the bill would increase state Medicaid costs by one-half of 1/10 of a percent. Of the 2,000 trans people enrolled in Medicaid in the state last year, 98 received gender-affirming treatment through the program.

But at the end of the day, Washington said the bill is emblematic of something bigger.

“This is really about ensuring that a person's income is not a barrier to them getting medically necessary treatment,” she said. “It's really about making sure that our most vulnerable Marylanders – that individuals with low income – are able to get what they need.”

The bill passed the Senate along party lines Monday. The House of Delegates will take it up in a committee on March 24.