By Nico Quintana and Danielle Askini
On Friday, May 30, a U.S. Department of Health and Human Services appeal board issued a landmark ruling overturning the 1989 Medicare policy categorically excluding transition-related medical procedures. This federal ruling is a huge victory for transgender people across the nation and means that transgender people receiving Medicare will no longer be automatically denied coverage for transition–related treatments. Medicare is a national health insurance program, administered by the U.S. federal government since 1966, that guarantees access to health insurance for Americans aged 65 and older who have worked and paid into the system, and younger people with disabilities.
Medicare recipients will now be able to work with their doctors to determine what transition-related care is right for them.
According to the National Center for Transgender Equality, “Now, decisions on coverage for transition-related care, like hormone therapy or surgeries, will be made on the basis of individual medical need and clinical standards, not outdated prejudices.”
What does this mean for transgender Oregonians?
This decision simply removes the national rule prohibiting Medicare coverage of transition-related care. However, it does not mean that any specific treatments will automatically be covered. Oregon Medicare recipients will need to work closely with their medical providers to determine what transition related health care treatments are needed for them.
There is still some uncertainty about how this ruling will be implemented and enforced – but Basic Rights Oregon will be monitoring this situation closely. Most doctors who accept Medicare are familiar with the process to get healthcare treatments approved, and for the first time in 35 years, transgender Oregonians enrolled in Medicare will have an opportunity to work with health care providers to have their individual health care deemed medically necessary.
How does this Medicare ruling fit in the bigger picture in Oregon?
Basic Rights Oregon’s Trans Justice Working Group identified access to health care as a top priority five years ago. Since then Basic Rights has been working through education, outreach and advocacy to remove barriers to health care, primarily focusing on public and private insurance coverage. The Department of Consumer and Business Services, which regulates insurance in Oregon, prohibited transgender health exclusions in many insurance plans. Basic Rights has worked with the City of Portland and other local governments and employers to achieve coverage for transition related care. For over two years Basic Rights has been advocating for removing prohibitions for trans care in the State Medicaid program (OHP). Starting in October, OHP will cover transition-related mental health services for youth and adults and puberty blockers for adolescents. And we’re continuing to work toward comprehensive transgender health care coverage. And, in a private lawsuit brought by a state employee and Lambda Legal, Esquivel v. Oregon, was settled by the Public Employees Benefits Board, removing exclusions in the health insurance provided to state public employees.
What’s next for trans equality?
Removing exclusions is only a first step to ensuring transgender people have the competent and accessible healthcare services we need. In Oregon and across the nation there is a serious lack of health care providers who are culturally competent. Even fewer providers are both competent in transgender healthcare and also take specific health insurance such as Medicare. Transgender people may face challenges when trying to access health care include finding a health care provider in Oregon offering transgender health care services as well as getting treatments approved by Medicare. Basic Rights Oregon will seek a meeting with the Medicare regional director’s office to clarify what this new ruling will mean for transgender Oregonians and to gain clarity on how this new rule will be implemented and enforced.
As we know, ensuring all transgender people have access to appropriate care is going to be a long and hard fight. Additionally, transgender people, especially transgender people of color have higher rates of health disparities, violence and rates of incarceration, which affects health and health outcomes for our communities. Basic Rights Oregon is dedicated to bringing about transgender health equality, and will continue to work diligently until it is fully achieved in Oregon. We will seek to remove transgender healthcare exclusions wherever they exist in Oregon and work to build community capacity in addressing transgender people’s healthcare needs. If you are passionate about our transgender justice work, please check out our Transgender Justice program here: http://www.basicrights.org/programs/transgender-justice/