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In Defense of Basic Health Care for Transgender New Yorkers

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Recently the New York Post incited concern over the much-overstated prospect of New York "taxpayers [footing] the bill for transgender residents to get 'sexual-reassignment surgery.'" The reality is that the proposal by members of the Health Disparities Committee of the New York Medicaid Redesign Team to repeal a discriminatory provision of New York's Medicaid regulatory scheme does little more than ensure equal treatment for Medicaid-eligible transgender New Yorkers.   As one Medicaid recipient explains of the exclusion: "You see, they think we take these medications just to take them... but these are not recreational things that we just do on the side just to feel pretty... this is our lives."

Medicaid recipients who are diagnosed with Gender Identity Disorder (GID) are currently refused treatment because of a biased and outdated regulation that discriminates against transgender individuals.   A proposal to New York State Governor Cuomo's Medicaid Redesign Team attempts to repeal this provision of the State's regulatory scheme that precludes coverage for medical care related to gender transition.   While the Metro and New York Post report that the proposal would cost the taxpayers of New York significantly, the reality is that the proposal saves on health costs and brings the state's program in line with state and federal law. 

Coverage for all transition-related health care is currently excluded under New York regulation N.Y.Comp.Codes R.& Regs.tit.18,§505.2(l).  What this means is that medically necessary hormone care that costs as little as $20 a month is excluded from coverage only for transgender individuals.  This blanket exclusion leaves transgender Medicaid recipients unable to access health care that prevailing medical standards confirm is medically necessary for patients with Gender Identity Disorder (GID). The American Medical Association, the American Psychology Association (APA) and the World Professional Association for Transgender Health (WPATH) have supported access to transition-related health care when a patient's doctor finds the treatment to be medically necessary.

In fact, Medicaid regularly pays for treatments like hormone therapy for many diagnoses but refuses to pay for the same treatments for people with diagnosed GID.  The same is true for procedures such as mastectomy and orchiectomy. This disparity of coverage based solely on diagnosis suggests that the exclusion of care for transgender people is based on political bias and hostility toward individuals who receive this care as part of a gender transition. In both cases, a patient's doctor declares the treatment to be medically necessary, but transgender people alone are denied. 

Covering this care not only has a huge impact on the everyday lives on transgender New Yorkers but also saves the state money.  It is well-documented that the denial of these necessary treatments to low-income people can lead to significant increases in incidents of depression, anxiety, substance use, long-term psychiatric hospitalization and suicide, all of which create additional costs to the state. This necessary transition-related care ultimately improves the quality of life and health outcomes for transgender individuals, creating more opportunities for people to access employment and shift onto private insurance. Reforming this regulation would save money, improve lives and support a shift toward meaningful health care reform for all.

For transgender Medicaid recipients in New York, the fight against this regulation has lasted for over a decade.  The Sylvia Rivera Law Project (SRLP), a collectively run, community-based organization providing free legal services to transgender, gender non-conforming and intersex people who are low-income or people of color, has worked with hundreds of individuals who have struggled to establish the medical necessity of treatments that the medical community has long considered necessary. SRLP continues to engage in direct services, litigation, policy and community outreach and education to challenge the negative effects of this regulation on our communities. As New York reflects on the financial and humanitarian viability of its Medicaid program, it is a fitting time to repeal this costly regulation that has targeted the transgender community for too long.