HHS Approves Pilot Undertaking to Mandate Gender Care Protection

The U.S. Department of Health (HHS) has approved Colorado’s application to require some private insurers in the state to provide gender-specific coverage.

Approval means that transgender-related care must be included as part of essential benefits in the state’s Affordable Care Act market, which includes individual and small group private insurance. Coverage begins January 1, 2023. Colorado will be the first state in the United States to require such coverage.

The HHS states that it should cover gender-affirming treatments that include eye and eyelid changes, face lift, facial bone remodeling for facial feminization, breast / breast augmentation and reductions, and laser hair removal.

“I am proud to stand by Colorado’s side in breaking down barriers that have historically made it difficult for transgender people to access health insurance and medical care,” HHS Secretary Xavier Becerra said in a statement .

“Extending Colorado’s essential health benefits to gender-affirming surgeries and other treatments is a model for other states, and we invite other states to follow suit,” said Chiquita Brooks-LaSure, administrator of Centers for Medicare & Medicaid Services in the explanation.

Medicaid already provides comprehensive transgender care in Colorado.

LGBTQ + advocacy group One Colorado estimates that thanks to the Affordable Care Act, only 5% of the state’s LGBTQ + community was uninsured in 2019, compared to 10% in 2011.

However, 34% of transgender respondents in a One Colorado survey in 2018 said they were denied coverage of an LGBTQ-specific medical service such as gender-based care. 62 percent said lack of or limited insurance was an obstacle to long-term care; 84% said another obstacle was the lack of adequately trained mental and behavioral medicine professionals.

Mental health also covered

The Colorado plan requires that individual and small group plans cover an annual 45- to 60-minute mental health exam with a qualified psychiatrist. The visit may include behavioral health screening, education and advice on healthy lifestyle changes, referrals for mental health treatment, and discussion of possible medications.

Plans must also include 15 additional opioid alternative drugs and up to six acupuncture visits per year.

“This plan expands access to mental health services for Coloradans while helping those struggling against substance abuse to overcome their addiction,” said Governor Jared Polis (D) in a statement.

“This will improve care for Coloradans and ensure that even more Coloradans have access to help when they need it,” he said.

Alicia Ault is a freelance journalist based in Lutherville, Maryland whose work has appeared in publications including JAMA, Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

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