New York Drops Medicaid's Ban on Trans Health Care

After requiring that most private health insurers in New York cover all medically necessary health care for trans people last week, Gov. Andrew Cuomo announced yesterday that Medicaid will also be required to do the same.

In 1998, New York's government explicitly stated that Medicaid, a federal health insurance program for low-income residents, "is not available for care, services, drugs, or supplies rendered for the purpose of gender reassignment," according to the Transgender Legal Defense and Education Fund. Last year, TLDEF submitted a 38-page letter urging Gov. Cuomo's administration to reconsider the 16-year-old decision.

Officials were still negotiating the decision when Gov. Cuomo issued a letter to all private insurers who provide mental health care coverage earlier this month, instructing them to cover all medically necessary care for trans subscribers, including talk therapy, hormone therapy, and gender-affirming surgeries.

With the new guidance, many are celebrating the fact that for the first time, the majority of trans citizens with health insurance will be able to access much needed, often life-saving medical care.

"I've known that I'm male for as long as I can remember. I just want to be comfortable in my own skin," 25-year-old Yonkers resident Adam Ramos said in a TLDEF statement. "I need to transition, and for me that means being able to get the health care I need through Medicaid which is my source of health insurance. I am happy that the state is finally taking action to help me get the medically necessary care I need to be the person I am."

However, not all insured trans New Yorkers will receive all the care they need, even with Gov. Cuomo's announcements.

Medicaid will not cover every gender-affirming procedure trans patients might require, according to TLDEF. And private insurers who do not cover mental health care will not be required to cover transition-related care, as trans patients still must be diagnosed with "gender dysphoria" -- defined in the Diagnostic and Statistic Manual of Mental Disorders as mental and emotional distress from incongruity between one's assigned sex and gender identity -- to qualify.

It remains unclear which transition-related health care will consistently be covered by Medicaid. While the American Medical Association and the American Psychiatric Association have made it clear that medical care which aligns a trans person's body with their gender identity is "medically necessary," at times, medical institutions differ on what procedures are included. For instance, a plan may cover talk therapy, doctor's visits, hormone therapy, and genital reconstruction for trans women, but may not consider permanent facial hair removal, facial reconstruction, or breast augmentation for coverage.

"We applaud the Cuomo Administration for taking this important step," said TLDEF Executive Director Michael Silverman in a statement. "But we call upon it to remove all restrictions for medically necessary transgender health care. Transgender New Yorkers suffer because their health care needs are excluded from New York's Medicaid program. This exclusion is rooted in bias, and serves only to harm some of the most vulnerable people in New York."

Silverman also took the moment to call on Gov. Cuomo's office to instate a comprehensive gender identity-inclusive nondiscrimination policy statewide to protect trans citizens from being fired from their jobs, evicted from their homes and denied public accommodations.

Medicaid's new trans-inclusive policy will go into effect following a 45-day comment period.