Major Victory- Transgender Healthcare To Be Covered by Medicaid
TUESDAY, DECEMBER 16, 2014

Transgender healthcare would be covered by Medicaid in New York for the first time since 1998 under a regulation proposed today by the state Department of Health. The proposal would cover medically necessary treatments for gender dysphoria—a medical condition recognized by physicians worldwide—including hormone therapy and sex reassignment surgery.

The proposed amendment was issued in response to Cruz v. Zucker, 14 Civ. 4456 (JSR), a class action lawsuit filed by The Sylvia Rivera Law Project (“SRLP”), The Legal Aid Society, and Willkie Farr & Gallagher LLP (“Willkie Farr”) on behalf of Medicaid-eligible transgender individuals who have been diagnosed with gender dysphoria and whose expenses were not reimbursable under the current regulation.
 
The state’s proposal would amend an existing regulation, 18 NYCRR 505.2(l), which prohibits Medicaid assistance for all forms of gender reassignment treatment. It provides: “Payment is not available for care, services, drugs, or supplies rendered for the purpose of gender reassignment (also known as transsexual surgery) or any care, services, drugs, or supplies intended to promote such treatment.”
 
“We appreciate the New York State Department of Health’s change in position which will allow this care to be available. We acknowledge that this plan is still less than perfect in that it limits gender affirming healthcare for young transgender Medicaid recipients. We would like to see more medically necessary treatments included in coverage. We hope that the guidance given to health insurance companies contracted with Medicaid will ensure that patients will have access to all care as recommended by their doctors,” says Kimberly Forte, Supervising Attorney of the Legal Aid Society’s LGBT Law and Policy Initiative. 
 
This change in the State's position to provide this health care comes after years of advocacy by the transgender communities of New York. Over the past several years, community members, advocates, doctors and allies have demanded that the State provide this care through direct actions, town hall forums, petitions, public comments and advocacy with the Medicaid redesign team. 
 
“Gender-affirming care has a powerful impact on the lives of transgender people. Medical experts across the nation agree that these treatments are safe, effective, and improve quality of life. So many low income people could not obtain this care because their insurance wouldn’t cover it. This new regulation will change lives,” says Elana Redfield, Staff Attorney with The Sylvia Rivera Law Project.