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Colorado to require some health insurance plans to cover gender-affirming care

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DENVER (AP) – Colorado will include gender-confirming care in its individual and small-group health insurance plans, state and federal officials said on Tuesday.

The state’s plan under the Centers for Medicare & Medicaid Services will include jaw, cheek and eye modifications, facial tightening, facial bone reshaping for facial feminization, construction and breast or chest reduction and laser hair removal.

Additional health benefits of Colorado’s plan include an annual mental health exam and expanded coverage of opioid alternatives for pain management, Democratic Governor Jared Polis said. The new plan adds 15 drugs as alternatives and will cover up to six acupuncture visits per year, according to the Colorado Insurance Division. The changes will take effect on January 1, 2023.

The Centers for Medicare & Medicaid Services, or CMS, has approved Colorado’s request to provide gender-confirming care as part of the state’s “essential health benefits,” which are requirements for individual plans and organizations. small employers spelled out in former President Barack Obama’s Affordable Care Act. .

Federal law does not require states to provide coverage for gender-confirming care in their state Medicaid programs, allowing state policies to range from banning all forms of gender-confirming care. the absence of a written policy on this type of coverage. This leaves thousands of transgender adults on Medicaid without coverage and creates a “gray area” where individuals must navigate plans with their health care providers, said Christy Mallory, legal director of the Williams Institute, a research institute. based at the University of California. Los Angeles Law School.

Mallory said that without insurance, much of gender-confirming care is “prohibitively expensive,” and including these services in insurance plans increases access to medically necessary care for trans people.

“People who need access to this care will not only be healthier because they receive the care they need through a doctor, licensed health care provider, but also that it will have positive effects on their overall health… able to make the transition and be fully themselves, ”Mallory said.

The CMS guidelines allow states to submit their own coverage requirements, but stipulate that they include certain categories such as prevention and wellness services, chronic disease management, maternity and newborn care. born, hospitalization, prescription drugs, treatment of mental health and addiction disorders, behavioral health, and laboratory services.

“States can be incredibly interested in what other states are doing,” Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, said at a press conference Tuesday. “I think Colorado is taking this step forward and asserting that desire will make other states look at their coverage as well and consider whether to add gender-affirming coverage as well.”

The announcement comes as Republican-led states passed several restrictions on the rights of transgender people this year. Arkansas became the first state to ban gender-confirming treatment or surgery for transgender youth. West Virginia was one of several states that approved restrictions on trans athletes. The Justice Department ruled in June that the laws of both states violated the 14th Amendment’s equal protection clause.

In June, two transgender women sued the state of Georgia, claiming they were denied access to gender-affirming health care under the state’s Medicaid program.

According to the Williams Institute, twelve states exclude gender care from Medicaid coverage and 20 states have not addressed it.

Gender care is considered a standard level of care by the American Medical Association, the American Academy of Family Physicians, and the American Psychiatric Association, the federal Department of Health said in a statement.

“For too long, too many transgender and non-binary people have struggled to access the health care they need, despite having health insurance,” said Democratic State Representative Brianna Titone, one of the few. elected transgender lawmakers in the United States. “These services are essential for the health and safety of LGBTQ + communities and will provide more Coloradians with the agency they need to assert their identity.

While insurance companies must cover some form of gender-affirming care, patient coverage varies and may exclude certain services even if a health care provider determines they are medically necessary, the Colorado Division of Insurance in a press release.

Colorado’s individual and small group health insurance plans cover nearly a quarter of state residents, Polis said.

Democratic State Senator Brittany Pettersen hailed the plan’s inclusion of opioid alternatives as changing a “system that encouraged overprescribing”, which she attributed to national lobbying by drug companies to suppliers who were receiving drugs. financial incentives.

“This is going to be significant for a third of Colorado’s population,” Pettersen said. “When they go to the doctor, they are going to be able to consider additional options instead of drugs which are often the cheapest initially but which take their toll later.”

Brooks-LaSure praised the new coverage of Colorado as part of the Biden administration’s commitment to remove barriers to coverage of LGBTQ + people.

“Gender care can save lives. By making this care essential, the referral plan will guide what is included in statewide health coverage, ”said Brooks-LaSure.

Colorado covers the most expensive consumer plans under the so-called reinsurance program that began in 2019, allowing insurers to moderate their rates. It has also allowed them to expand their coverage, especially in rural areas where, in the past, scarce or no competition has provided some of the highest premiums in the country for many parts of Colorado.

A new law aims to allow residents to save on health care by forcing insurers to offer a standard state-supervised health plan to individuals and small businesses from 2023. By 2025, it requires premium reductions of 15% compared to the plans currently offered.

Polis has made accessibility and affordability of healthcare a priority since his election in 2018.

He and the Democrats who control the legislature seek to import cheaper prescription drugs from overseas, address health care inequalities exposed by the coronavirus pandemic, impose transparency on hospital prices, reduce prescription drug costs, cap insulin prices and strengthen mental health care, among many others. other initiatives.

Nieberg is a member of the Associated Press / Report for America Statehouse News Initiative corps. Report for America is a national, nonprofit service program that places reporters in local newsrooms to cover undercover issues.

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