Maryland lawmakers push to expand Medicaid coverage for transgender people

In light of recent changes in federal policy, Senators Mary L. Washington (D-Baltimore City) and Dale Ann R. Kaiser (D. Montgomery) are urging the Department of Health to redesign its Medicaid policy regarding transgender health care in Maryland.

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In light of recent changes in federal policy, Senators Mary L. Washington (D-Baltimore City) and Dale Ann R. Kaiser (D. Montgomery) are urging the Department of Health to redesign its Medicaid policy regarding transgender health care in Maryland.

Washington and Caesar Wrote to the Maryland Department of Health Minister Dennis R. Schrader said in early April that the state was at risk of prosecution for violating nondiscrimination provisions under the Affordable Care Act. That’s because the current policy includes only a small set of gender confirmation procedures, includes many exceptions and a long list of criteria that must be met to receive covered services.

“We strongly urge the administration to develop new policy in line with legal requirements and defined by best clinical practice in providing gender-affirming health care to our transgender population,” they wrote.

In a phone call on Friday afternoon, Washington said the letter was her way of making sure she had done “due diligence in exploring all avenues to accomplish this.”

“[I] He hoped a legislative track would not be necessary,” Washington said.

Kaiser and Washington co-sponsored A invoice During the 2022 legislative session that would have expanded the coverage of gender-affirming medical services available to those with private insurance for Medicaid recipients.

The legislation was passed by the Senate but seemed to disappear After the vote of the House Health and Governmental Operations Committee.

Tricia Rudy, deputy director of the Medicaid program at the Department of Health, She responded to Washington and Caesar This week, he indicated that the agency would not review its policy.

“[W]While we will continue to review new federal developments as appropriate, MDH has determined that there is no need to change existing Maryland Medicaid coverage at this time,” Rudy wrote on Wednesday.

In April, the US Department of Health and Human Services announce That the sex-discrimination provisions of the Affordable Care Act would be interpreted to include a ban on discrimination on the basis of gender identity and sexual orientation.

According to Washington and Kaiser, the federal agency supports transgender patients who file discrimination complaints to require states to comply. They warned Schrader that the state is at risk of litigation for not providing appropriate sex-affirmation care benefits through Medicare and Medicaid plans.

They also said that the Ministry of Health may face discrimination lawsuits from its private citizens Law.

“Maryland cannot wait any longer for the department to update its policy,” Washington and Keizer wrote.

Uniquely targeting and distinguishing

Maryland Medicaid Program Policies It requires organizations under state Medicaid to cover certain transgender health services, including outpatient mental health services for gender dysphoria, hormone replacement therapy, lab services and gender confirmation surgery.

In order for a patient to be eligible for gender confirmation surgery, they must prove that they have suffered from chronic gender dysphoria for at least two years.

According to the Mayo Clinic, sexual dysphoria is the intense feeling of distress in people whose gender identity differs from the gender they were identified at birth.

The patient’s dysphonia must not be the result of another mental illness. However, under Maryland policy, dysphonia must be so severe that it causes “clinically significant distress” or impairs an individual’s ability to function in social or work settings.

If they have another clinical psychiatric disorder — such as bipolar disorder, dissociative identity disorder, or borderline personality disorder — the patient should be treated or receive psychiatric treatment before a doctor signs up for gender confirmation surgery.

Patients must then also be evaluated and two signed letters from qualified mental health professionals received. At least one of them must have a Ph.D.

These letters should indicate that the patient has been on hormone replacement therapy for at least one year and, if possible, detail how long they have been on treatment as their gender.

If a patient is seeking a mastectomy, a monogram will be required and she does not need to undergo ongoing hormone replacement therapy.

Breast augmentation is not covered unless the physician prescribing the hormones trusts that the patient’s breast size continues to cause severe psychological distress after one year of hormone replacement therapy.

While Maryland health care plans are required to cover gender confirmation surgery, other services, such as those that reconstruct the face, remove hair, or change the voice—and the second stage of a female-to-male genital reconstruction procedure—are not covered.

Many of these exceptions go against the recommended care standards From the World Professional Association for Transgender Health.

“These exceptions uniquely target and discriminate against transgender people,” Washington and Keizer wrote. “As such, the policy failed to comply with state and federal law.”

Rudy said the Department of Health has compared its current policy with that of other states and reviewed the International Professional Association for Transgender Health’s Standards of Care.

‘categorical exceptions’

Aside from their claims that the state’s current policy is discriminatory, Washington and Kaiser say it violates federal Medicaid law.

under federal lawservices provided under health care plans must be “sufficient in quantity, duration, and scope to reasonably achieve their purpose” and cannot “arbitrarily refuse or reduce the amount, duration, or scope of service required…only because of the diagnosis and type of disease or condition” .

According to lawmakers, Medicaid in Maryland “creates categorical exceptions to gender-assertive care” and “fails to provide adequate treatment.”

They also said that politics is violated Maryland Regulations Actwhich states that managed care institutions must provide services and information that address “the individual needs of their participants, regardless of gender, sexual orientation or gender identity.”

In addition, Washington and Caesar alleged that the state is violating a Regulation Require care organizations to provide members with gender dysphoria with needed medical treatments — not just gender confirmation surgery.

Rudy said the state’s Medicaid plan provides “post-transition services as medically necessary.”

She wrote, “…Current Maryland Medicaid Gender Affirmation Care coverage provides access to transgender and nonbinary health care in Maryland within the statutory powers of Medicaid and President Biden’s federal executive order.”