New York State Issues Guidance Requiring Health Insurance Companies to Cover Transgender Health Care

The Transgender Legal Defense & Education Fund (TLDEF) today praised the New York State Department of Financial Services for issuing guidance requiring health insurance companies to cover transgender health care on the same terms as other care.

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The new rule bars insurance companies from denying medically necessary care because the treatment is for gender dysphoria, a diagnostic term used to refer to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth. Most policies currently exclude coverage for such treatment, regardless of whether or not a doctor determines that the treatment is medically necessary. The state’s new rule renders those exclusions void and requires that insurance companies cover transgender health care.

“Transgender people have suffered because of discriminatory health insurance exclusions that target the medically necessary care they need. We thank and congratulate New York State for moving aggressively to ensure that transgender people can access the same health care that everyone else receives,” said TLDEF Executive Director Michael Silverman. “We commend New York Governor Andrew Cuomo and State Superintendent of Financial Services Benjamin Lawsky for taking this important step to eliminate health care discrimination. We thank New York State Senator Brad Hoylman for his leadership in helping to bring about this change and for including TLDEF in the process.”

Health care related to gender transition has been widely recognized as medically necessary by organizations such as the American Medical Association, the American Psychological Association and the World Professional Association for Transgender Health. New York becomes the 10th jurisdiction to ban health insurance discrimination against transgender people, joining California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont, Washington, and Washington D.C. In May, the federal government also ended its decades-long exclusion of coverage for certain services related to gender transition under Medicare.

As TLDEF celebrates this action, it urges New York to take the next step and remove the discriminatory exclusion of transgender health care from its Medicaid program, which is not subject to the new guidance.

“Transgender Medicaid recipients are some of New York’s most vulnerable citizens. They must be able to access medically necessary care,” said Silverman. “This action ordering insurance companies to stop discriminating against transgender people should immediately prompt the state to do the same thing and drop its own Medicaid exclusion. We call upon the Governor and the Department of Health to make that change now.”