Got progress? Cuomo mandates that Medicaid cover sex change operations

According to a regulatory dictate proposed this week by Governor Cuomo, NY’s Medicaid program will soon cover the cost of sex change surgery and hormone therapy for transsexual beneficiaries. The rule follows on the heels of Cuomo’s decision to mandate private insurers to offer the same procedures.

The Cuomo administration claims the new regulation is a civil rights issue and in keeping with the governor’s declaration that New York is the “progressive capital” of the United States. A lawsuit filed by advocates who claim the existing policy is discriminatory also helped to facilitate the change.

“New York has always been a progressive leader and ensuring that all New Yorkers – regardless of gender identity – are treated fairly will continue this legacy,” Governor 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. I am proud that the state is taking this step and continuing to lead the fight on transgender rights.”

Under the regulations, hormone therapy and gender reassignment surgery, commonly referred to as sex change, will be covered for persons who have referrals from medical professionals. Cuomo’s regulations do not address the controversial issue of juvenile sex change operations, as the surgery will be covered only for individuals who are a minimum age of 18 or 21 years old, depending on specific circumstances.

The Cuomo administration’s edict follows the lead of the Obama administration’s Health and Human Services decision in May 2014 to allow Medicare to cover the cost of sex change operations for gender dysphoric senior citizens. A lawsuit had also been filed challenging the 33-year-old ban against Medicare funding the procedures, which can cost up to $60,000 plus thousands of dollars per year for hormone maintenance.

Cuomo’s office stated that California, Massachusetts, Oregon, Vermont and Washington D.C. also have Medicaid programs that cover the cost of sex change operations. Moreover, according to Politico: “In late 2012, Oregon [became] the first state to direct private insurers to pay for transition procedures deemed medically necessary. California, Vermont, Colorado, Connecticut and Washington, D.C., have done the same, and major cities such as San Francisco and Rochester, N.Y., cover their employees.”

Transsexual advocates have been enthused with the changes. Michael Silverman, executive director of Transgender Legal Defense and Education Fund, said, “This is an absolute sea change in the way that insurance for transgender people will cover their health care needs. This essentially opens up an entire world of treatment for transgender people that was closed to them previously.”

However, the general public has not been overly warm to the new policies, social conservatives oppose them and many in the insurance industry fear mandating coverage of sex change operations might open the gateway to increased mandates in general.

The proposed new Medicaid regulations in New York would require a medical professional to document that a patient has persistent gender dysphoria (not feeling one’s gender identity is consistent with their physical sex), has received appropriate hormone therapy for a minimum of one year, has lived a minimum of one year in their preferred gender role and has received mental health counseling.

The public will have 45 days to comment on the proposed Medicaid regulation.

New York State also recently revised its birth certificate policy to allow transgender people to step back in time and “correct” their birth certificates to reflect their chosen biological sex.

American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and the National Center for Lesbian Rights have led legal efforts to change regulations and laws pertaining to transgender persons. The groups are behind the lawsuits against New York, other states and the federal government, claiming non-coverage of sex change operations is discriminatory.