NY Governor Cuomo Says Insurers Must Cover Trans* Healthcare

[Content Note: Transphobia; class warfare.]

This is good news (with caveats): Democratic New York Governor Andrew Cuomo has told insurance companies "that they will no longer be allowed to deny gender reassignment surgery or other treatment to change a person's gender, like hormone therapy, if a doctor has deemed that treatment medically necessary."

In a letter being sent to insurance companies this week, the governor said that because state law requires insurance coverage for the diagnosis and treatment of psychological disorders, people who are found to have a mismatch between their birth sex and their internal sense of gender are entitled to insurance coverage for treatments related to that condition, called gender dysphoria.

"An issuer of a policy that includes coverage for mental health conditions may not exclude coverage for the diagnosis and treatment of gender dysphoria," the governor's letter says.

...The rule makes New York the ninth state to require the coverage, the Transgender Legal Defense and Education Fund, an advocacy group, said on Wednesday. The others are California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont and Washington, according to the group. Washington, D.C., also mandates it.

The group said that most insurance policies currently exclude coverage for transgender treatment, and at best include it as a more expensive rider to a standard plan.

"This is an absolute sea change in the way that insurance for transgender people will cover their health care needs," Michael Silverman, executive director of the fund, said. "This essentially opens up an entire world of treatment for transgender people that was closed to them previously."

And now the caveats: Because access to healthcare in the US is still primarily through insurance, and because access to insurance in the US is still primarily through employers, and typically only to full-time employees, and because trans* people still face a lot of employment discrimination and disproportionate levels of poverty, and because of a critical shortage of doctors with expertise in treating trans* patients, it's not a simple thing for many trans* people to get access to a doctor who will say their treatment is medically necessary.

Even a trans* person with health insurance and access to a doctor who is versed in trans* care and willing to stipulate gender/sex reassignment surgery is a medical necessity might find that, because so few doctors perform GRS/SRS (or even hormone therapy), they don't have any in-network coverage anyway.

In the best case scenario, you still have to have insurance; doctors are still acting as gatekeepers; and the trans* community is still colossally underserved by the medical community—and how underserved is hugely dependent on where you live, what your state's guidelines are, and how close you live to knowledgeable medical practitioners who abide those guidelines.

Guidelines which, by the way, don't standardize what's "medically necessary." Most (or all) insurance plans refuse to cover facial hair removal for trans women, for example. So a doctor can agree that it's medically necessary for a trans patient's health and well-being, but that can't force insurance companies to cover it.

So, this is very good progress, and is still wholly insufficient.

Two other quick things: Note that this guideline is still predicated on a mental health diagnosis of gender dysphoria. (Which itself is a whole other post.) That means that trans* patients still have to get access to a mental healthcare provider with trans* expertise as well as a physician with trans* expertise.

Also: I'm wondering how much the focus on "sex changes" will undermine trans* activism around dismantling the binary and/or not having to have GRS/SRS in order to make changes to official documents, access gender-specific resources and venues, etc. Giving people access to surgical options should not mean that people are required to have surgery. But, to many cis gatekeepers with rudimentary understandings of trans* diversity, access often translates into expectation. Clearly the objective is to create more options, not fewer.

[My thanks to Eastsidekate for contributing her thoughts to this piece.]