Biden administration OKs Colorado expansion of transgender health coverage

Many private health insurance plans in Colorado will soon be required to cover “gender affirming care” for transgender patients under a landmark approval granted by the Biden administration.

For the first time, plans purchased on the state’s individual and small group markets — meaning employers with less than 100 workers —  will be required to cover transition-related care. The change would take effect on Jan. 1, 2023.

According to state figures, the small group and individual health insurance markets cover about 20 percent of Coloradans.

The treatments will include hormone therapy, genital reconstruction, face tightening, facial bone remodeling and other services.

Biden administration officials said the hope is Colorado can provide a model for other states to ensure access to potentially lifesaving care.

“For too long, transgender people have faced barriers that make it difficult for them to access doctors, affordable coverage and medical treatment,” Chiquita Brooks-LaSure, the administrator for the Centers for Medicare and Medicaid Services (CMS), said during a press conference in Colorado alongside the state’s governor, Jared Polis (D).

She said the Biden administration is “committed” to acting on its promise of expanding access and removing barriers to care for LGBTQ+ people. The administration earlier this year said it would reverse Trump-era limits on health care protections against discrimination based on gender identity and sexual orientation.

CMS in a statement said it recognizes that expanded, gender-affirming coverage “vastly improves health care outcomes for the LGBTQ+ community, reduces high rates of depression, anxiety, and suicide attempts as well as decreases substance use, improves HIV medication adherence, and reduces rates of harmful self-prescribed hormone use.”

The changes to the coverage rules would add expanded coverage for transition services to ObamaCare’s “essential benefits” all plans must guarantee to their customers. 

While ObamaCare defines the broad categories of essential health benefits, states have the flexibility to develop health plans that detail the specific services covered based on a typical employer plan.

“Health care should be in reach for everyone; by guaranteeing transgender individuals can access recommended care, we’re one step closer to making this a reality,” Department of Health and Human Services Secretary Xavier Becerra said in a statement. “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.”

According to Polis, all insurance companies in the state must cover some form of gender-affirming care. However, coverage varies by insurance company, is not always comprehensive and may include explicit exclusions for certain services, even if a health care provider determines a service to be medically necessary.

In other states, especially those run by Republican governors, access to gender-affirming care is extremely limited. 

The previous administration’s HHS kept protections against discrimination based on race, color, national origin, sex, age or disability. But officials narrowed the definition of sex to only mean “biological sex,” specifically cutting out transgender people.