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Oregon, California regulators require transgender health coverage

Wednesday, January 16, 2013

SALEM, Ore. — Regulators in Oregon and California have quietly directed some health insurance companies to stop denying coverage for transgender patients because of their gender identity.

The states aren’t requiring coverage of specific medical treatments. But they told some private insurance companies they must pay for a transgender person’s hormone therapy, breast reduction, cancer screening or any other procedure deemed medically necessary if they cover it for patients who aren’t transgender.

The changes apply to companies insuring about a third of Oregonians and about 7 percent of Californians, but not to people on Medicare and Medicaid or to the majority of Californians who are insured through a health management organization, or HMO.

Advocacy groups said the action is a major step forward in their long battle to win better health care coverage for transgender Americans.

“It’s just a matter of fairness,” said Ray Crider, a 28-year-old transgender man from Portland. “I just never felt that I was like anybody else. I see everybody else being taken care of without having to fight the system.”

Officials in both states said the new regulations aren’t new policies but merely a clarification of anti-discrimination laws passed in California in 2005 and in Oregon two years later.

Many health insurance policies broadly exclude coverage of gender identity disorder or classify it as a pre-existing condition. Transgender patients are often denied coverage for medical procedures unrelated to a gender transition, advocacy groups said, because insurance companies deem the condition to be related to their sex reassignment.

Some transgender patients also have trouble getting access to gender-specific care. A person who identifies as a man might be denied coverage for ovarian cancer screening or a hysterectomy. A transgender woman might be denied a prostate screening.

The state insurance regulators said those procedures, if covered for anybody, must be covered for all patients regardless of their gender.

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Filed under: California, Oregon

4 more reader comments:

  1. That is great news for our Transgender communities!

    Posted on Wednesday, January 16, 2013 at 10:47pm
  2. <3

    Posted on Wednesday, January 16, 2013 at 10:54pm
  3. <3

    Posted on Wednesday, January 16, 2013 at 11:48pm
  4. Read carefully – they are only requiring a few companies to pay for treatments they cover for anyone who is not transgender.

    I.e. if your insurance covers breast cancer screening, which it should for everyone, now a trans woman or a trans man can also access it.

    Unless they’re insured through Medicare/Medicaid or through an HMO.

    So really, this means very little for the vast majority of trans people. All it means is that a few people can get the care they’re paying for anyway.

    Posted on Thursday, January 17, 2013 at 6:22am