|new proposed regulations|
"Treatments" for gender dysphoria, including sex reassignment surgery and hormone therapy, could soon be covered under New York's Medicaid program, according to aproposed rule from the state's Department of Health.
If the rule is adopted, New York would become the fifth state to allow its Medicaid program to pay for "therapies" that not long ago were considered experimental by some and deviant by others.
The state's Medicaid program will cover hormone therapy and surgery for those 18 years of age and older and for people who have been living for at least a year in a gender role that is "congruent" with their gender identity, the posting said.
The program will not cover reversal of prior surgeries and some cosmetic procedures, according to the proposed rule, which was posted one week after Governor Andrew Cuomo announced New York's private insurance companies will no longer be allowed to deny coverage for transgender New Yorkers.
While the move is a win for LGBT proponents who have been pushing for this for years, some advocates expressed regret that certain services may not be covered.
"This is a terrific step in the right direction," said Michael Silverman, executive director of the Transgender Legal Defense & Education Fund. "I think there is a bit more work to do."
Silverman was particularly concerned with the state's decision not to cover certain procedures such as breast augmentation or drugs that promote hair growth or loss.
These may seem cosmetic, but could also be essential for mental health, he said.
"Medical necessity and not an arbitrary list of procedures should be the touchstone for whether coverage is available," Silverman said.
New York State continues settlement negotiations in a class action lawsuit brought by patients seeking coverage through Medicaid.
Kim Forte, supervising attorney for the Legal Aid Society LGBT law and policy initiative, said they want the regulations to be finalized before they are comfortable settling with the Cuomo administration.
"We haven't settled the case because we want the public comment period to run it course," Forte said. "There needs to be guidance issued to the private insurers contracting with Medicaid. We expect to see that guidance as part of settlement litigation."
There is also a hope from some that the age requirements may be changed.
“After years of advocacy, we’re thrilled that transgender New Yorkers will finally be able to access medically necessary health care through Medicaid,” Nathan Schaefer, executive director of Empire State Pride Agenda, said in a press release. “The news of this long-awaited regulatory change will mean that Medicaid can longer discriminate against what the American Medical Association, the American Psychological Association the World Professional Association of Transgender Health and many other organizations agree is critical care that should not be denied. We’re hopeful subsequent iterations of this policy will be fully inclusive of all care and for all ages, as this change does not apply to all services nor to those under the age of 18.”
The move is expected to cost the state $6.7 million, a figure arrived at by taking the number of Medicaid recipients now receiving mental health services for gender dysphoria—353 natal males and 308 natal females—and then estimating how many of those would seek some sort of therapy.
"New York State has always been a progressive leader and ensuring that all New Yorkers—regardless of gender identity—are treated fairly will continue this legacy," Cuomo said in a statement. "This new regulation will guarantee transgender New Yorkers access to Medicaid-funded care, which is critical to safeguarding the principle or equal treatment. I am proud that the state is taking this step and continuing to lead the fight on transgender rights."
The state prohibited payment for gender reassignment surgery through Medicaid in 1998, a position adopted because "there was a lack of consensus regarding the safety and efficacy" of the procedure, the state register said.
“Since that time, a body of credible medical evidence has been developed supporting the conclusion that GRS (gender reassignment surgery) is a safe and effective treatment for gender dysphoria in medically necessary cases, and is no longer considered experimental,” the proposed rule states. “Significantly, in May of 2014, the federal government through the Departmental Appeals Board of the Department of Health and Human Services ruled that Medicare could no longer deny coverage of GRS on the grounds that it is ineffective, unsafe, experimental, or controversial, that it has a high rate of complication or has not been subjected to controlled, long-term studies, or that the criteria for diagnosing gender dysphoria is inconsistent or problematic.”
The new regulation is subject to a 45-day comment period before it can take effect.
Gov. Cuomo approved a new policy Tuesday night allowing impoverished transgender New Yorkers to bill taxpayers for sex-change surgery.
The Cuomo administration issued new rules requiring New York’s highest-in-the-nation $55 billion Medicaid program — the government health-insurance program for the needy — to foot the bill for “gender reassignment” operations.
State officials estimate the expanded coverage for transgender operations and services will cost the Medicaid program $6.7 million a year.
There are 353 men and 308 women on Medicaid who have been diagnosed with gender-identify disorder.
The state Department of Health estimated that a portion of these individuals will seek either hormone therapy or reassignment surgery.
The cost for sex-change operations — which include testicle removal, breast augmentation and mastectomy — ranges from $15,000 to $50,000. That doesn’t include thousands of dollars in therapy and counseling services.
Medicaid will pick up the tab for transgender New Yorkers who are over 18, although the patients must be 21 to get surgery that results in sterilization.
“New York state has always been a progressive leader and ensuring that all New Yorkers — regardless of gender identity — are treated fairly will continue this legacy,” Cuomo said.
“This new regulation will guarantee transgender New Yorkers access to Medicaid-funded care, which is critical to safeguarding the principle of equal treatment,” he said.
“I am proud that the state is taking this step and continuing to lead the fight on transgender rights.”
New York joins Oregon, Massachusetts, Vermont, Washington, DC, and Maryland in offering "medical" services to transgender residents.
But Republican leaders slammed Cuomo’s move as outrageous.
“Sometimes you just have to say ‘no,’ and this is clearly one of them,” said Westchester County Executive Rob Astorino.
“New Yorkers pay the highest property taxes in America because our Medicaid costs already are through the roof, Putting taxpayers on the hook for sex change operations when they often struggle to pay for their own basic health-care needs is ridiculous, no matter how it’s spun,” he said.
State Sen. Martin Golden (R-Brooklyn) predicted the Medicaid costs for sex-change operations will be much higher.
“The state is saying it will cost $67 million over ten years. It will be over $100 million. It’s an inappropriate use of taxpayer dollars,” Golden said.
Cuomo’s move also will make it easier for foster-care residents in the city’s care who identify as transgender to get sex-reassignment surgery through Medicaid. The city — as well as the state — has been sued for discrimination after refusing to pay for such services.
“We look forward to working with the State in the implementation and roll out of these "critical" and "lifesaving" health care provisions for the transgender community,” Speaker Melissa Mark Viverito and the Council’s LGBT Caucus said in a join statement.
“We applaud the Cuomo administration for taking this important step,” said Michael Silverman, director of the Transgender Legal Defense & Education Policy. “New York is poised to become a model state when it comes to the protection of its transgender residents.”
But Silverman objected to Cuomo limiting the transgender services to adults while continuing to exclude youths.