HHS Okays First US Pilot to Mandate Coverage of Gender-Affirming Care

Alicia Ault

October 13, 2021

The US Department of Health and Human Services (HHS) has approved Colorado's request to require some private insurers in the state to cover gender-affirming care.

The approval means transgender-related care must be included as part of the essential benefits offered on the state's Affordable Care Act marketplace, which includes private individual and small group insurance plans. The coverage will start January 1, 2023. Colorado is the first state in the United States to require such coverage.

The HHS notes that gender-affirming treatments to be covered include eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal.

"I am proud to stand with Colorado to remove barriers that have historically made it difficult for transgender people to access health coverage and medical care," said HHS Secretary Xavier Becerra in a statement.

"Colorado's expansion of their essential health benefits to include gender-affirming surgery and other treatments is a model for other states to follow and we invite other states to follow suit," said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure in the statement.

Medicaid already covers comprehensive transgender care in Colorado.

The LGBTQ+ advocacy group One Colorado estimated that, thanks to the Affordable Care Act, only 5% of the state's LGBTQ+ community was uninsured in 2019, compared to 10% in 2011.

However, 34% of transgender respondents to a One Colorado poll in 2018 said they had been denied coverage for an LGBTQ-specific medical service, such as gender-affirming care. Sixty-two percent said that a lack of insurance or limited insurance was a barrier to care; 84% said another barrier was the lack of adequately trained mental and behavioral health professionals.

Mental Health Also Covered

The Colorado plan requires individual and small group plans to cover an annual 45- to 60-minute mental health wellness exam with a qualified mental health care practitioner. The visit can include behavioral health screening, education and consultation about healthy lifestyle changes, referrals to mental health treatment, and discussion of potential medication options.

The plans also must cover an additional 15 medications as alternatives to opioids and up to six acupuncture visits annually.

"This plan expands access to mental health services for Coloradans while helping those fighting substance abuse to overcome their addiction," said Governor Jared Polis (D), in a statement.

"This improves care for Coloradans and ensures that even more Coloradans have access to help when they need it," he said.

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including JAMA, Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

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