Colorado becomes first state to include gender-affirming treatments in essential health benefits
DENVER — Gender-affirming care is now included as an essential health benefit for thousands of Coloradans, Governor Jared Polis announced in an October 12 press conference.
Colorado will be the first state to offer gender-affirming care as part of the Essential Health Benefit (EHB) benchmark plan. This applies to Coloradans who are enrolled in individual plans (i.e., not from an employer) or small group plans (i.e., for small employers with less than 100 employees). That group makes up about a quarter of the state's population, Polis estimated. People enrolled in Colorado's Medicaid plan already have coverage for transition-related services.
In a historic first, the Centers for Medicare & Medicaid Services (CMS) approved Colorado’s request to include gender-affirming care in the new plan, which is set to take effect in January of 2023.
“For too long, transgender people have faced barriers that have made it difficult for them to access doctors, affordable coverage and medical treatments. Today marks the first time that a state has sought to add additional gender-affirming care as an essential health benefit,” said CMS administrator Chiquita Brooks-LaSure in a press conference with Polis. “We hope that this marks a historic beginning and that other states look to Colorado as a model and take advantage of the opportunity to ensure that their benchmark plan meets the needs of all people in their communities.”
According to a news release from CMS, the gender-affirming care will include treatments like “eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal.”
Under the Affordable Care Act, states are required to provide coverage in 10 broad categories of EHBs such as maternity care and emergency services. You can see those 10 categories here. As Colorado did in this case, states are permitted to create state-specific “benchmark” plans that include certain services and treatment under those 10 broad categories.
In addition to gender-affirming procedures, the updated coverage in Colorado’s benchmark plan includes annual mental health exams and “this plan also addresses substance abuse disorders by expanding the number of opioid alternatives that insurance companies will cover to 15, including the option of acupuncture for pain management,” Polis explained.
Asked about the cost of the additional coverage areas in the benchmark plan, Colorado Division of Insurance Commissioner Mike Conway said it was “negligible;” people enrolled in the plan will see an increase of just 64 cents a month, he said.
Polis added that the updated coverage will save people substantially more than it will cost them, “particularly in the form of reducing opioid dependency, which is tremendously costly from a human and financial perspective.”
Multiple speakers at the governor’s press conference touched on the importance of gender-affirming care for transgender individuals, especially when it comes to their mental health.
Conway said the treatment is important to “make sure that people can get the care that they need to live the life that they want to live and the life that they actually identify with.”
Brooks-LaSure said the treatment could be “life-saving.”
[Related: For many pregnant transgender people, competent medical care is hard to find]
A recent study from the Seattle Children’s Gender Clinic found that gender-affirming hormone treatments for transgender and non-binary youth participating in the study led to a 60% decrease in moderate and severe depression and 73% decrease in suicidality.
But such treatment has also become a political issue. In Arkansas earlier this year, for example, the state legislature overruled Republican Governor Asa Hutchinson’s veto and enacted a ban on gender-affirming care for transgender youths.
Dr. Robert Garofalo, division head of adolescent and young adult medicine at Lurie Children’s Hospital in Chicago said that kind of legislation is “not just anti-trans. They’re anti-science. They’re anti-public health.”
“These last 18 months have been difficult for everybody,” Polis said in reference to the COVID-19 pandemic, “but we’ve also seen the impact on people's mental health and in some cases the pandemic has intensified behavioral health and substance abuse issues that Coloradans are facing.”
Kyle Cooke is the Digital Media Manager at Rocky Mountain PBS. You can reach him at kylecooke@rmpbs.org.