With a Democratic governor now in office, transgender rights advocates and some lawmakers are optimistic that the General Assembly will finally pass a bill that expands gender-affirming health coverage for individuals receiving Medicaid benefits.
For the second year in a row, Baltimore and Montgomery County Democrats State Sen. Mary Washington and Del. Anne Kaiser have introduced the Trans Health Equity Act. It’s a bill that former Republican Gov. Larry Hogan threatened to veto in 2022. The bill fizzled out at the end of the legislative session last year.
The legislation broadens which treatments would be covered under Medicaid to be more aligned with what private insurers offer individuals.
Medicaid is a health insurance program jointly managed by federal and state government for low-income individuals typically younger than 65 years old.
While Medicaid provides some gender-affirming treatments, there are others that fall outside of its scope.
For example, the ability for individuals to change their hair, modify their voice through therapy and even medical care that makes alterations to their face or neck. In addition, some individuals may choose to preserve aspects related to fertility.
The Maryland Department of Health estimates the out-of-pocket costs for such services range between $800 and $53,000. Some services may cost less than a few hundred dollars but surgery to change a person’s face would cost upwards of $50,000.
“We want to ensure that medically necessary care has up to date standards, that government bureaucracy is taken out of the patient medical relationship and we need to and want to reduce sex-based discrimination by providing health care based on clinical need,” Washington said Tuesday in Annapolis.
Providing gender-affirming care decreases rates of anxiety, depression and other adverse mental health outcomes, according to the Journal of the American Medical Association, a significant body of research.
Del. Kris Fair, a sponsor of the bill and chair of the Maryland Legislative LGBTQ Caucus, said that is particularly important for one of the most vulnerable populations in Maryland.
“One study shows that shows that 60% of transgender and non-binary youth will attempt suicide by the age of 18,” Faire said. “Individuals who are trans and non-binary, are struggling because society continues to put unnecessary layers of adversity in their place. Eventually, that adversity can become overwhelming for people. And these are simple solutions that we can take out of the way of trans and non-binary people to allow them to live a more authentic life, and to provide them with a sense of hope and optimism for their experience.”
There are roughly 24,000 transgender individuals across the state, according to the Maryland Department of Health. About 6,000 of whom are enrolled in Medicaid.
In 2022, about 100 people received gender-affirming care through the state’s Medicaid program. It’s estimated that the bill would increase that number by 25 individuals.
Maryland Department of Health officials say if each of those 125 people were to utilize every single new gender affirming treatment under the bill, which is not possible, it would increase Medicaid state expenditures by $7.6 million in total.
That ends up being about 0.6% of the overall $11.7 billion Maryland spent on Medicaid in 2019.
Editor's Note: This story has been updated to accurately reflect the name of a Maryland General Assembly Caucus.
