Colorado will need some health insurance plans to cover gender-affirming care

DENVER (AP) — Colorado will include gender affirmation care in its individual and small group insurance plans, state and federal officials announced Tuesday.

The state’s plan under the Centers for Medicare & Medicaid Services includes jaw, cheek, and eye adjustments, facial tightening, facial bone remodeling for facial feminization, breast or breast construction and reductions, and laser hair removal.

Additional health benefits to Colorado’s plan include an annual mental health exam and comprehensive coverage of opioid alternatives for pain management, Democratic Governor Jared Polis said. The new plan adds 15 medications as an alternative and covers up to six acupuncture visits per year, according to the Colorado Division of Insurance. The changes will take effect on January 1, 2023.

The Centers for Medicare & Medicaid Services, or CMS, approved Colorado’s request to provide gender-affirming care as part of the state’s “essential health benefits,” which are requirements for individual and small employer plans as set forth in the Affordable Care Act of former President Barack Obama.

Federal law does not require states to provide coverage for gender-affirming care in their state Medicaid programs, so state policies can range from banning all forms of gender-affirming care to not having a written policy for this type of coverage. This leaves thousands of transgender adults on Medicaid without coverage and creates a “grey area” where individuals must navigate plans with their health care providers, said Christy Mallory, legal director of the Williams Institute, a research institute based in the University of California Los Angeles. School of Law.

Mallory said that without insurance, much of gender-affirming care is “prohibitively expensive,” and incorporating these services into insurance plans increases access to medically necessary care for transgender people.

“People who need access to this care will not only be healthier because they get the care they need through a doctor, through a licensed healthcare provider, but also that it will have a positive effect on their overall health… as a result of the fact that they are able to switch and be their full selves,” said Mallory.

CMS guidelines allow states to submit their own coverage requirements, but stipulate that they include certain categories such as preventive and wellness services, chronic disease management, maternity and newborn care, hospitalization, prescription drugs, mental health treatment, and substance use disorders, behavioral health, and laboratory services.

“States can be incredibly interested in what other states are doing,” Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, said at a news conference Tuesday. “I think Colorado taking this step of moving forward and affirming this desire will lead other states to look at their reporting as well and think about adding gender-affirming reporting.”

The announcement comes as Republican-led states have introduced several restrictions on transgender rights this year. Arkansas became the first state to ban gender-affirming treatments or surgery for transgender youth. West Virginia was one of the states to pass restrictions on transgender athletes. The Justice Department ruled in June that the laws in both states violate the equal protection clause of the 14th amendment.

In June, two transgender women sued the state of Georgia for… denied access to gender-affirming health care under the state’s Medicaid program.

Twelve states exclude gender-affirming care from Medicaid coverage, and 20 states have not addressed it, according to the Williams Institute.

Gender-affirming care is considered a standard of care by the American Medical Association, the American Academy of Family Physicians and the American Psychiatric Association, the federal health department said in a release.

“For too long, too many transgender and non-binary people have struggled to access the health care they need, despite having health insurance,” said Democratic state representative Brianna Titone, one of a handful of elected transgender lawmakers. in the U.S. critical to the health and safety of LGBTQ+ communities and will provide more Coloradans with the agency they need to confirm their identities.”

While insurance companies must cover some form of gender-affirming care, patient coverage varies and certain services may be excluded even if a health care provider determines it is medically necessary, the Colorado Division of Insurance said in a statement.

Colorado’s individual and small group insurance plans cover nearly a quarter of the state’s residents, Polis said.

Democratic state Senator Brittany Pettersen praised the inclusion of opioid alternatives in the plan as changing a “system that encouraged over-prescribing,” which she attributed to national drug company lobbying that amounted to suppliers getting financial incentives.

“This will be meaningful to a third of Colorado’s population,” Pettersen said. “When they go to the doctor, they can look at additional options instead of drugs that are often the cheapest, but later wreaked havoc.”

Brooks-LaSure praised the new coverage in Colorado as part of the Biden administration’s commitment to removing barriers to coverage for LGBTQ+ people.

“Gender-affirming care can be life-saving. By making this care essential, the benchmark plan will guide what is included in statewide health coverage,” Brooks-LaSure said.

Colorado covers the highest-cost consumer plans under the so-called reinsurance program that began in 2019, allowing insurers to moderate their rates. It has also allowed them to expand their coverage, especially in rural areas where historically scarce or no competition has yielded some of the country’s highest premiums for many regions of Colorado.

A new law aims to save residents on health care by requiring insurers to offer a standard state-controlled health plan to individuals and small businesses from 2023. By 2025, it will require premium cuts of 15% over the plans currently on offer.

Poli has prioritized healthcare accessibility and affordability since his election in 2018.

He and the Democrats who control the legislature seek to import cheaper prescription drugs from abroad, address health inequalities exposed by the coronavirus pandemic, impose transparency on hospital prices, reduce the cost of prescription drugs. lower insulin prices, and strengthen mental health, among many other initiatives.

Nieberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a national, not-for-profit service program that places journalists in local newsrooms to report on classified issues.

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