On Monday I posted about the State of New York's demand that the states insurers cover treatment of transgender people (New York expands health care coverage for transgender people) and mentioned what a shame it was that New York's Medicaid program did not cover that same treatment.
I wasn't the only person who noticed that flaw.The Sylvia Rivera Law Project and the Legal Aid Society filed a lawsuit on the same day as the letter to the insurers was released (last Thursday) challenging a 1998 regulation which prevented Medicaid recipients in New York from accessing transgender-related healthcare. The lawsuit was filed in Federal Court in Manhattan against the state health commissioner seeking class action status on behalf of Medicaid recipients seeking hormone therapy and sex reassignment surgery.
A similar federal lawsuit was thrown out in 2008 by a Manhattan judge who said the state had sufficiently explained its rejection of such reimbursement in 1998.
The judge in the 1998 case "noted that the state cited serious complications from the surgeries and danger from life-long administration of estrogen and testosterone."
The SRLP/Legal Aid suit challenges the state under the Affordable Care Act and cites fresh evidence which now "conclusively proves the treatments are safe and effective."
In the last 15 years there have been significant medical advances.
--Elena Redfield, SLRP
The lawsuit notes that several weeks ago, the federal Department of Health and Human Services concluded it was unreasonable to reject Medicare coverage for all gender reassignment surgery based on a 1981 report encompassing studies published between 1966 and 1980.
It said there is evidence that the medical community has since reached a consensus that gender reassignment surgery is an effective treatment for psychological dysfunction brought about a mismatch between a person's birth gender and a person's perception of it.
Redfield estimated that more than 8000 New Yorkers would be affected by the litigation.
There's been a climate change and this is the right time for courts to be looking at this issue and for society to be discussing this and fixing these discriminatory practices.
--Kimberly Forte, Legal Aid
The lawsuit was filed on behalf of Angel Cruz, 50, of the Bronx and I.H., 36, of Manhattan.
According to the lawsuit, I.H.'s self-confidence, mental stability and physical comfort suffer because of the mismatch of her birth gender with her gender identity. It said a doctor has blamed mental diagnoses of severe bipolar disorder, post-traumatic stress disorder, anxiety with panic and insomnia on her gender-based disability and said depression leaves her bedridden for extended periods.
The lawsuit said Cruz has identified herself as female since age 10 and she "struggles as a result of having a physical body that does not match her gender identity."
Cruz said she at times has resorted to the black market to obtain hormone treatments.
"I never thought I was a boy, never,"
The state
sought to render the lawsuit moot today by proposing the authorization of
Medicaid coverage for transgender medical treatment (exclusions noted at this link).
Regulations proposed Wednesday would cover hormone therapy and gender reassignment surgery.
For surgery, patients would need a medical referral and to have counseling and document a year of hormone therapy and living in the gender role consistent with his or her identity.
They would have to be at least 18, or 21 if surgery means sterilization.
The proposal is subject to public comment through February 2...and I have no doubt our detractors will provide a substantial amount of that.
Gov. Andrew Cuomo says the Medicaid proposal is "critical to safeguarding the principle of equal treatment."
The state estimates this expansion of coverage would cost approximately $6.74 million. The state says that there are currently 671 New Yorkers receiving mental health services through Medicaid based on the diagnosis of gender dysphoria.
Currently California, Massachusetts, Oregon, Vermont, and the District of Columbia cover transgender health care through Medicaid.