Feds Propose Expansion Of Insurance Rule To Require Trans Related Care

Federal health officials have taken the first step in creating federal rules which would require all insurance plans to cover medically necessary transition related care for transgender people.
"Hopefully soon, transgender people throughout the country will finally be able to access the health care that is so fundamental to their well-being," said Mara Keisling, executive director of the National Center for Transgender Equality. "We are hopeful that, as the data suggests, this will help reduce rates of depression, suicidality and substance abuse among transgender people, as well as alleviate stress-related health conditions that all people have when they aren't getting the care they need and that their doctor orders."
Under the new rules, which were published Sept. 3 and still require final approval by the agency, any health insurance sold on state or federal exchanges will have to provide medically necessary care for transgender people. That means Medicaid, Medicare, Children's Health Insurance Program, The Indian Health Service and others will have to lift the broad bans currently in force with those plans.
Michigan Medicaid plans all have bans on transgender transition related care in them. Officials from the Michigan Department of Health and Human Services did not immediately return calls seeking comment on the proposed new rules.
Whether all federal programs will have to follow the new rule is up in the air according to NCTE.
"Some private health insurance plans outside the Marketplaces may not be covered if they are offered by issuers who do not also offer Marketplace plans or receive other federal funds," NCTE staff wrote in a press release last week. "The rule does not address non-HHS federal health programs such as veterans' and military health care, but those agencies are responsible for applying Section 1557 to their programs. HHS said it is also considering whether to join other federal agencies in interpreting the ban on sex discrimination to include bias based on sexual orientation, and whether to allow healthcare providers to discriminate against women or LGBT people because of the provider's religious belief. NCTE will advocate vigorously for protection for all LGBT people and against any religious right to discriminate against anyone."
The new rule will also require transgender people to be treated without discrimination. That means, regardless of what gender is presented in their medical charts, they will be allowed to have gender specific medical tests done such as prostate and breast cancer exams. The new rule would also require that transgender people be allowed to access and use services specific to their gender identity and expression.
"This proposed rule is an important step to strengthen protections for people who have often been subject to discrimination in our health care system," Health and Human Services Secretary Sylvia M. Burwell said in a press release sent out by the White House. "This is another example of this Administration's commitment to giving every American access to the health care they deserve."
The White House press release also highlighted the following things the proposed rule will do in opening up effective health care:
* Women must be treated equally with men in the health care they receive. Other provisions of the ACA bar certain types of sex discrimination in insurance, for example by prohibiting women from being charged more than men for coverage. Under Section 1557, women are protected from discrimination not only in the health coverage they obtain but in the health services they seek from providers.
* Individuals may not be subject to discrimination based on gender identity. For example, some insurance policies have historically contained categorical exclusions on coverage of all care related to gender transition. Those categorical exclusions are prohibited under the proposed rule. Individuals must also be treated consistent with their gender identity, including in access to facilities.
* The rule bolsters language assistance for people with limited English proficiency, so that individuals are able to communicate more effectively with their healthcare providers to, for example, describe their symptoms and understand the treatment they have been prescribed. The proposed rule provides clear guidance on the requirements of the law with regard to provision of language services, such as oral interpreters and written translations.
* For individuals with disabilities, the rule contains requirements for the provision of auxiliary aids and services, including alternative formats and sign language interpreters, and the accessibility of programs offered through electronic and information technology.
Comments on the proposed rule will be accepted until Nov. 6, 2015 with final rules to follow sometime within the next year.