State Insurance Commissioner Mike Kreidler sent a letter to Washington health insurers Wednesday urging them to cover medical services needed by transgender people. In a news release, he said that insurers covering medically necessary services cannot deny those services based on a patient’s gender status or identity.
The independently elected commissioner indicated that future regulations could be drawn up if insurers do not comply. The letter addresses transition services for transgender people that are availaeble to others - such as hormone therapy, counseling, mastectomies, breast augmentation and breast reconstruction.
“Transgender people are entitled to the same access to health care as everyone else,” Kreidler said in the release. “Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”
The move follows efforts by the state Health Care Authority to ensure coverage for transgender state employees needing treatments by 2016. Medicare also acted last month to end a practice of automatically denying coverage of gender reassignment surgery and other services, and HCA is also reviewing requirements in the Medicaid program it manages for those who are poor. Kreidler said that decisions to deny coverage based on gender identity alone violate the state’s 2006 non-discrimination law as well as the federal Affordable Care Act.
It was not immediately clear how insurers will react. Some have provided policies without exclusions for corporations and governments.
Advocacy group Coalition for Inclusive Healthcare applauded the effort to end discriminatory health-coverage decisions that affect transgender individuals. The group, which advocates for transgender people, said exclusions that deny coverage of treatments needed by transgender people can be found in most private and public health insurance plans sold in Washington. It said some insurers use exclusions to deny coverage for care unrelated to gender identity such as therapy or routine blood work.
“Removing these outdated exclusions brings Washington up-to-date with the latest information from medical experts and will provide transgender Washingtonians with access to life-saving and medically necessary health care,” Danielle Askini, member of the Coalition for Inclusive Healthcare and advocacy director of the Gender Justice League, said in a news release.
“Because of these exclusions, medically necessary care is being denied to transgender individuals on a daily basis,” Seth Kirby, board president of Pride Foundation and director of Oasis Youth Center in Tacoma, said in a release earlier in the week. “These are people’s lives that are at stake.”
Washington’s Public Employees Benefits Board is moving toward including such coverage in benefit plans for 2016. But some board members also want to remove specific exclusions in policy plans even earlier. Advocates including Askini brought the coverage issue in April and May to the PEBB, which administers insurance plans covering more than 350,000 state employees, family members and retirees through the benefits board.
“This will require careful, thoughtful work on our part and due diligence to develop a comprehensive, evidence-based benefit … that assures the highest quality of care” for transgender people, Dan Lessler, chief medical officer for the state Health Care Authority, told the PEBB in May.
Kreidler is asking that anyone “unfairly denied medical services by their health insurer” to file a complaint online with his office file it by calling 800-562-6900. He also plans a review of health plans to see where there are exclusions.