Aleisha, a trans woman of color with masculine facial features, has endured decades of suffering. Because her face “outs” her as a transgender woman, she’s had to deal with discrimination at work and when looking for housing. She’s also been the victim of physical violence, and often avoids going out in public because she fears for her safety.
Over time, she has undergone surgeries to reduce the size of her forehead, nose and jaw so that her facial features will align with her feminine self. Unfortunately, for Aleisha, who asked that we use only her first name, her Medicaid insurer has denied coverage for these procedures, labeling them “cosmetic.”
That’s about to change.
Thanks to years of advocacy and countless appeals to Michigan’s Department of Insurance and Financial Services (DIFS), a new policy set to take effect on Nov. 1 will mandate that Medicaid insurers follow guidelines established by health experts when determining coverage for trans people.
It’s a major step forward. For people diagnosed with gender dysphoria (a condition where a person’s gender identity and gender expression are not congruent with the sex assigned at birth), being able to access medically necessary treatments is essential for their wellbeing. Because of that, the World Professional Association for Transgender Health (WPATH), an international organization made up of transgender healthcare experts, has developed guidelines for different kinds of medical treatments for people with gender dysphoria. These established standards of care include mental health support, hormone therapy and gender-confirming surgeries.
Similarly, the Endocrine Society, a global organization of endocrinologists who study and advance the use of hormone therapy, publishes guidelines for transgender-related medical care. Both organizations see gender-confirming surgeries such as facial feminization as a medically necessary treatment for gender dysphoria.
Unfortunately, many health insurance programs ignore this expertise. Instead, they broadly exclude coverage for most trans-related health procedures, classifying them as cosmetic. Many of these insurers, in addition to operating in the private sector, also have contracts with the state of Michigan to serve Medicaid plans, which provide health insurance to people who have lower incomes.
This is a significant issue for the 150,000-plus transgender people who rely on Medicaid for health insurance coverage. The Williams Institute at the UCLA School of Law, in a 2019 study, reported that 29.4 percent of the U.S. transgender population lives in poverty, as compared to 11.4 percent of the overall population. For decades, Michigan’s Medicaid program permitted taxpayer-funded Medicaid insurers to apply blanket coverage exclusions on trans-related health care.
In November, those insurers will have to have to follow WPATH and Endocrine Society standards of care when making decisions regarding coverage of transgender-related medical treatment. In other words, Medicaid insurers will have to listen to the experts and follow medical science.
As a result, Michigan’s transgender Medicaid recipients will have much greater access to the medical care needed to treat their gender dysphoria, allowing them to live their authentic lives.
For trans people such as Aleshia, the hope is that the new policy will drastically improve quality of life issues by extending Medicaid coverage to gender confirming procedures, medications, surgeries and other supports.
Pride Source writer Jay Kaplan has dedicated a great deal of time to advocating on behalf of trans people who have been denied Medicaid coverage. He says that some of his most gratifying and meaningful work has been with the ACLU of Michigan, where he was able to call clients with the good news that they had won the appeals that would allow them to receive gender affirming care, including gender confirmation surgery. Kaplan says he is happy to forgo that work when the Medicaid policy goes into effect in November.