Oregon Medicaid to extend coverage to gender dysphoria treatments

PORTLAND, Ore. — Oregon’s Medicaid program will soon pay for gender reassignment surgery, hormone therapy and other treatments for transgender patients, becoming on Thursday the third state besides the District of Columbia to extend coverage to gender dysphoria treatments.

A panel of health experts added the condition to the list of treatments covered by the Oregon Health Plan, the state’s version of Medicaid, which provides publicly funded health coverage for nearly 1 million people.

Officials estimate that about 175 Medicaid patients per year will seek treatment for gender dysphoria, in which a person identifies with the opposite gender they received at birth, at an annual cost of less than $150,000.

“This is an historic step forward toward fairness and equality for transgender Oregonians,” said Danielle Askini, policy director for the advocacy group Basic Rights Oregon.

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Oregon joins California, Vermont and Washington, D.C., in covering gender dysphoria treatments under Medicaid, Askini said.

The coverage for gender dysphoria, previously known as gender identity disorder, is set to begin Jan. 1. The Oregon Health Authority still must formally change its rules to eliminate a prohibition against covering gender reassignment surgery – a process that’s has already started and will involve a public comment period, said Karynn Fish, an agency spokeswoman.

Oregon insurance regulators in 2012 ordered private insurance companies to cover treatments for gender dysphoria. A lawsuit forced the state to cover treatments for public employees.

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With Medicaid patients gaining coverage, the last segment of Oregon’s health insurance market not required to cover gender dysphoria treatments is the Oregon Educators Benefit Board, which covers school district employees, Askini said.

Oregon’s Medicaid program operates under a waiver from the federal government that allows the state to determine which treatments are covered based on their cost-effectiveness. Advocates seeking insurance coverage of surgical and hormonal treatments say they significantly reduce the risk of suicide attempts and their associated medical costs while reducing depression.

“The reasons these exclusions have existed is purely discrimination,” Askini said. “When you compare it to any other kind of medical intervention … apples to apples, this is a very cost-effective intervention.”