January 12, 2013 in City, Health

Transgender health costs to be covered in two states

Oregon, California tell insurers not to deny care
Jonathan J. Cooper Associated Press
 
Equal treatment

State regulators don’t have authority to force insurance companies to cover specific procedures, like hormone therapy or genital reconstruction. But they’ve told insurers that if they provide breast reduction for patients with back pain, they can’t deny it for a gender reassignment that’s been deemed medically necessary. Insurers could unilaterally exclude coverage of, say, breast implants, but it would have to apply to all policyholders equally, including breast-cancer patients.

SALEM – Regulators in Oregon and California have quietly directed some health insurance companies to stop denying coverage for transgender patients because of their gender identity.

The states aren’t requiring coverage of specific medical treatments. But they told some private insurance companies they must pay for a transgender person’s hormone therapy, breast reduction, cancer screening or any other procedure deemed medically necessary if they cover it for patients who aren’t transgender.

The changes apply to companies insuring about a third of Oregonians and about 7 percent of Californians, but not to people on Medicare and Medicaid or to the majority of Californians who are insured through a health management organization.

Advocacy groups said the action is a major step forward in their long battle to win better health care coverage for transgender Americans.

“It’s just a matter of fairness,” said Ray Crider, a 28-year-old transgender man from Portland. “I just never felt that I was like anybody else. I see everybody else being taken care of without having to fight the system.”

Officials in both states said the new regulations aren’t new policies but merely a clarification of anti-discrimination laws passed in California in 2005 and in Oregon two years later.

Many health insurance policies broadly exclude coverage of gender identity disorder or classify it as a pre-existing condition. Transgender patients are often denied coverage for medical procedures unrelated to a gender transition, advocacy groups said, because insurance companies deem the condition to be related to their sex reassignment.

Some transgender patients also have trouble getting access to gender-specific care. A person who identifies as a man might be denied coverage for ovarian cancer screening or a hysterectomy. A transgender woman might be denied a prostate screening.

The state insurance regulators said those procedures, if covered for anybody, must be covered for all patients regardless of gender.

The California regulations took effect in September and apply only to insurance products regulated by the California Department of Insurance. The agency primarily regulates preferred provider plans, or PPOs, that covered about 7 percent of the population in 2010, according to data from the California Health Care Foundation.

The Oregon Insurance Division issued its guidance last month in the form of a bulletin to insurers. It applies to commercial insurance companies that cover about a third of the state’s population; the rest are uninsured, on Medicare or Medicaid, or work for a large employer that’s self-insured.

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