LGBT Task Force Examining Transgender Insurance Coverage

Guest post: Lois Uttley, Director, Raising Women’s Voices – NY


The NYS Department of Financial Services issued a Circular Letter in December 2014 requiring private health insurance plans in our state to cover all medically-necessary care for treatment of gender dysphoria. With the one-year anniversary of this policy approaching, the LGBT Task Force of Health Care for All New York (HCFANY) is determining whether private health insurance plans are complying with this policy.

LGBT healthThe LGBT Task Force is inviting transgender individuals, as well as their clinicians and advocates, to share their experiences with us and with state officials at “listening sessions” to be held this fall in three locations: New York City, Albany and Rochester. The goal of these sessions is to identify systemic problems with insurer compliance with the transgender coverage policy, so that we can work with state officials and insurers to address the problems. The sessions will be invitation-only and will not be open to the public or media for confidentiality purposes. We are taking special steps to ensure the comfort of transgender individuals who are willing to testify.

The listening sessions are planned to highlight the wide range of challenges transgender individuals experience when trying to use their private health coverage to obtain needed care. For example, such problems might include difficultly obtaining pre-certification approval, denials of coverage for surgical procedures and lengthy appeal processes.

If you have a recent story about how you, your client or your patient has had difficulty obtaining approvals for private health insurance coverage of transgender care, please fill out the form at, and a Task Force member will get in touch shortly.  Please note that these experiences must have taken place since December 2014, when the new policy was issued, and must concern private insurance coverage, not Medicaid coverage (which we will analyze in a later stage of this process). Please direct all Medicaid stories to the email, and Task Force members will reach out to you in the next phase of this project.

The majority of non-elderly Americans get their health coverage through employer sponsored plans, but the ways those plans provide financial protection is changing. According to a new survey by the Kaiser Family Foundation, employers are increasingly relying on cost-shifting through high-deductible plans, higher premiums, and plans with larger co-pays. That means workers and their families have more to lose when healthcare costs spike.


Tools such as price transparency calculators and employee wellness programs are growing in popularity as consumers are pushed to treat healthcare purchasing decisions more like other household expenses. It may pay to shop around and avoid unnecessary office visits or procedures, but healthcare costs are not like other household purchases. Price tags don’t always communicate value, and high quality care is not one-size-fits-all. For some consumers paying more to get the care that suits their needs is the only viable option. The rise of narrow networks, which offer few choices of providers and hospitals in an effort to curb costs to insurers, exacerbates the problems these consumers face.


With wages increasing slowly, consumer advocates are on the alert for healthcare costs that prevent workers from seeking necessary, high-quality care. Nobody should forgo a trip to the doctor when they’re ill because they can’t meet their deductible or afford the copay. The American narrative of employer sponsor health insurance only works if employees aren’t impoverished the moment they need services.

By Andrew Leonard, Sr. Policy Associate for Health, Housing and Income Security, Children’s Defense Fund – NY


Starting this November, many low- and moderate-income New Yorkers will be able to enroll in a new comprehensive and affordable health insurance product, known as the Essential Plan. Without a doubt, the New York State of Health Marketplace has been a huge success in New York State, enrolling over 2 million people in coverage, many for the first time! Yet, despite these significant gains, some New Yorkers find themselves without insurance or struggling to afford the private insurance have, even with financial assistance from the Marketplace. Many of these individuals will be newly eligible for the Essential Plan.

o-BEST-HEALTHCARE-facebookLike Qualified Health Plans, the Essential Plan will cover all of the ten Essential Health Benefits, including emergency services, inpatient hospitalization, primary care, urgent care, sick visits, lab work, radiology, reproductive health care and more.

Those who qualify for the Essential Plan will pay a premium of either $0 or $20, depending on their income. There will be no deductible, but some consumers may be required to pay a small co-pay for services like doctor visits, hospital stays, and prescription drugs.

The Essential Plan will be available to US citizens earning more than the Medicaid eligibility threshold, but less than 200% of the Federal Poverty Level (FPL) (e.g. a single person earning more than $16,242 but less than $23,540). Lawfully-present immigrants, such as green card holders and those seeking refugee status, will be eligible for Essential Plan coverage as long as they earn less than 200% of the FPL. That means that most lawfully-present immigrants below the Medicaid income threshold, currently eligible for state-funded Medicaid, will be transitioned to Essential Plan coverage.

Enrollment in the Essential Plan begins November 1, 2015 for coverage beginning January 1, 2016. From then on, eligible individuals will be able to enroll all year long, not just during the Marketplace’s Open Enrollment period. It’s an exciting time in New York State!

To enroll or learn more about the Essential Plan, contact the NY State of Health at (855)-355-5777 or

You can also get free one-on-one help from a Navigator or Certified Application Counselor, certified by NY State of Health, who serves your area: Or contact Community Health Advocates: (888)-614-5400 or

One of the bills that will make its way to the Governor’s desk this summer will protect infants who qualify for Child Health Plus, the state’s free or low cost health insurance program for children, from a coverage gap at birth.

Currently, a family must enroll a child after the child’s birth and coverage begins up to 45 days later. This gap in coverage is an unnecessary stressor on a family that should be able to focus on welcoming their new child. Any gap in coverage forces infants to go without much needed care and places financial strain on low and moderate income families.

The legislation that recently passed both houses of the legislature (A7155B/S4745B) makes an important change by allowing for coverage to begin on the date of a child’s birth when their parent enrolls the baby in coverage prior to their birth or within 60 days of the birth.

Governor Cuomo must still sign the bill for it to become law. HCFANY urges the Governor to sign A7155B/S4745B to assure that babies eligible for Child Health Plus have health coverage right from the start.