Nevada: State Health Insurers Cannot Discriminate Against Trans People

Trans state employees in Nevada, as well as trans family members of state employees, can breathe easier after July 1: their health insurance will now cover medically necessary transition-related medical procedures.

Nevada's Public Employee Benefits Program board voted in November that prior language excluding coverage for talk therapy, hormone therapy, or gender-affirming surgeries for patients diagnosed with gender dysphoria from coverage should be removed from the state's self-funded and HMO plans, reports the Las Vegas Review-Journal.

"Gender dysphoria" is a term used by the American Psychiatric Association that refers to feeling distress or discomfort at an incongruity between one's gender identity and one's sex assigned at birth. Health care that addresses this dysphoria is considered "medically necessary" by the APA and the American Medical Association, but is routinely denied coverage by insurance companies, making health care prohibitively expensive for many trans people.

The decision is being hailed by Nevada trans advocates as a positive step forward, especially for a state that hasn't always been progressive on transgender issues. In March, Nevada's assembly was considering an anti-trans "bathroom bill" that ultimately failed in a 22-20 vote.

"We commend the Nevada state PEBP board for making this significant step to ensure that transgender employees have access to lifesaving care," Brock Maylath, president of Nevada's Trangsender Allies Group, told the Review-Journal. "Medical treatment should be determined by conversations between a patient and a doctor, rather than on arbitrary exclusions created by an insurance company."

Despite this progress, however, not all trans Nevadans will be able to access the health care coverage they need, as the changes apply only to those on the state's health insurance program, excluding those on private insurance.

As is common with many health insurance providers, certain transition-related procedures are still deemed "cosmetic" by Nevada state insurers and will therefore not be covered, including hair or skin removal and facial reconstruction. Only one gender-affirming surgery is covered in each patient's lifetime, despite the fact that many trans patients seek both chest and genital reconstructions.

Nevada now joins New York, California, Colorado, Connecticut, the District of Columbia, Massachusetts, Oregon, Washington, and Vermont in eliminating at least some statewide barriers to trans-inclusive health insurance policies. Last summer, the Obama administration declared that trans Medicare patients and federal employees could have gender-confirming surgeries covered under federal health insurance.