New York State to Lift Ban on Medicaid Coverage for Transgender Health Care

 

On December 17, 2014, New York Governor Andrew Cuomo and the New York State Department of Health proposed a new regulation that would eliminate a 1998 regulation stating that Medicaid coverage “is not available for care, services, drugs, or supplies rendered for the purpose of gender reassignment.” 

Once the regulation takes effect, New York will join California, Massachusetts, Oregon, Vermont, and Washington D.C., which cover transgender health care through their Medicaid programs. In May 2014, the federal government also ended its decades-long exclusion of coverage for certain services related to gender transition under Medicare.

Health care related to gender transition has been widely recognized as medically necessary by organizations such as the American Medical Association (AMA), the American Psychological Association (APA), and the World Professional Association for Transgender Health (WPATH). 

While it does propose coverage for hormone therapy and certain surgical procedures, New York State’s new regulation still excludes other treatments that may be medically necessary for some people.  It continues to exclude coverage for anyone under 18.  The new regulation is subject to a 45-day comment period before it can take effect.

A week before the Medicaid regulation was introduced, it was announcement that New York State law now requires private health insurance companies to cover transgender health care on the same terms as other care. It also follows New York State’s and New York City’s revisions to their birth certificate policies for transgender people. Both the city and the state have rejected surgical requirements and now issue corrected birth certificates when a licensed medical provider states that a transgender individual has received appropriate clinical treatment.