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Maryland bill expanding trans health care to Medicaid passes House in nick of time, advocates say

Maryland House of Delegates in session in Annapolis, Maryland.
Matt Bush
Maryland House of Delegates in session in Annapolis, Maryland.

Editor's Note: After this news story was published, the Maryland Senate approved the Trans Health Equity Act 32-14 on March 20 in the evening.

A bill that would expand Medicaid coverage options for transgender individuals across Maryland passed the House of Delegates just before the legislative deadline, known as Crossover Day, this past weekend.

Crossover Day is when one of the two legislative bodies must pass a bill for it to have any chance of making into law this session, which is March 20 this year.

The House of Delegates passed the Trans Health Equity bill by a vote of 93-37 on March 18.

“All the reliable research out there supports this bill,” said Del. Anne Kaiser, a Montgomery County Democrat and bill sponsor said on the House floor Saturday.

On March 20, the Maryland Senate passed the bill 32-14 in the evening.

The trans health care 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.

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, another bill sponsor 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.

Scott is the Health Reporter for WYPR. @smaucionewypr
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