Colorado Gov. Jared Polis. (Washington Blade file photo by Michael Key)
DENVER (AP) | Colorado will include gender confirmation care in its individual and small group health insurance plans, state and federal officials announced Oct. 12.
The state’s plan under the Centers for Medicare & Medicaid Services will include jaw, cheek and eye modifications, face tightening, facial bone remodeling for facial feminization, breast or chest construction and reductions and laser hair removal.
Additional health benefits for Colorado’s plan include an annual mental health exam and expanded coverage of opioid alternatives for pain management, Democratic Gov. Jared Polis said. The new plan adds 15 drugs as alternatives and will cover up to six acupuncture visits per year, according to the Colorado Division of Insurance. The changes will go into effect Jan. 1, 2023.
The Centers for Medicare & Medicaid Services, or CMS, approved Colorado’s request to provide gender-confirming care as part of the state’s “essential health benefits,” which are requirements for individual and small employer plans set forth under former President Barack Obama’s Affordable Care Act.
Federal law does not require states provide coverage for gender-confirming care in their state Medicaid programs, allowing state policies to range from banning all forms of gender-affirming care to not having a written policy on this type of coverage. This leaves thousands of transgender adults on Medicaid without coverage and causes a “gray area” where individuals have to navigate the plans with their health care providers, said Christy Mallory, legal director at the Williams Institute, a research institute based in the University of California Los Angeles’ School of Law.
Mallory said that without insurance, much of gender confirming care is “prohibitively expensive,” and including these services in insurance plans increases access to medically necessary care for trans people.
“People who need access to this care will not only be healthier because they are getting the care they need through a doctor, through a licensed health care provider, but also that that will have positive impacts on their health overall … as a result of being able to transition and be their full selves,” Mallory said.
CMS guidelines allow for states to submit their own coverage requirements but stipulate that they include certain categories such as preventive and wellness services, chronic disease management, maternity and newborn care, hospitalization, prescription drugs, treatment for mental health and substance use disorders, behavioral health, and lab services.
