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 ACA makes insurance more affordable for people through a cost-sharing reduction (CSR) benefit. CSRs are available to consumers with incomes between 138% and 250% of the Federal Poverty Line ($27,311 to $49,475, for a family of three) who purchase Silver level plans. CSRs are sliding scale discounts on cost sharing, including deductibles, co-pays, and co-insurance. New analysis from Washington D.C.-based Avalere Health of nationwide Marketplace enrollment for 2015 shows that only 73% of enrollees eligible for cost-sharing reductions chose Silver level plans. Thus 2.2 million consumers forfeited this benefit.

According to Avalere’s analysis, “consumers may not be aware that CSRs are available and the benefits they offer. ‘Additional consumer education and more sophisticated decision support tools are likely needed to ensure that all patients are accessing the benefits available under the Affordable Care Act,’ said Elizabeth Carpenter, vice president at Avalere. ‘Specifically, consumers need tools that highlight the tradeoff between monthly premiums and out-of-pocket costs and demonstrate the benefits of cost-sharing reductions.’”

In New York, however, 78% of eligible enrollees chose plans that came with CSRs – 5% better than the national average. New York also saw a steep curve between the three CSR tiers: 97% of those eligible for the highest level of CSR subsidy – 94% actuarial value – enrolled in Silver plans; but only 62% of people eligible for the lowest level of CSR subsidy – 73% actuarial value – enrolled in Silver plans (see graph below). This suggests that New York consumers are making strategic enrollment decisions. New York’s 11,000 assistors, who disproportionately serve consumers with lower incomes, are likely a part of our success story.

CSR levels graph 2New York’s data also suggest that consumers eligible for the lowest level CSRs (CSR-III) – with a $1200 deductible – may still face affordability problems. These consumers may be choosing Bronze level plans to save money on premiums, or they may forgo CSRs altogether and “buy up” to Gold level plans.

Come 2016, consumers in the CSR-I and CSR-II bands will qualify for the Essential Plan (EP), which will have very low cost or no cost premiums and minimal cost sharing. This may underscore the affordability issues facing consumers eligible for the CSR-III subsidies, earning between $39,581 and $49,475, for a family of three.


By Claudia Calhoon, MPH, Director of Health Advocacy, New York Immigration Coalition; Laura F. Redman, Director, Health Justice Program, New York Lawyers for the Public Interest; and Sarika Saxena, Staff Attorney, Health Justice Program, New York Lawyers for the Public Interest


The release of the 2015 Open Enrollment report from the New York State of Health (NYSOH) demonstrates that NYSOH made important progress in reaching New York’s culturally diverse immigrant communities this year. The New York Immigration Coalition (NYIC) and New York Lawyers for the Public Interest (NYLPI) supported a number of strategies for effective outreach, such as a Spanish-language version of the web portal and outreach materials in 17 different additional languages. HCFANY is excited to see that New York has made concrete progress toward making the Marketplace friendly and accessible for all immigrant communities.

Other important accomplishments in the report include:

  • 13% of enrollees selected Spanish as their primary language (as opposed to 10% in 2014)
  • 25% of Marketplace enrollees describe themselves as Hispanic, a population that is disproportionately likely to be uninsured (an increase from 21% in 2014)
  • Help from the NYSOH call center was given in 92 different languages, suggesting that information on coverage is reaching a wide array of diverse communities.
  • Availability of an interactive calendar of events, navigation tools, and new “How to” videos in English and Spanish.

These successes point to the Affordable Care Act’s approach of working with in-person assistors, NYSOH Navigators and certified application counselors. Many Navigators and CACs work at strong culturally competent and language proficient immigrant-serving organizations, offering enrollment assistance in a total of 48 different languages.

The report also highlights important areas for improvement for open enrollment 2016 and beyond. Enrollment for French, French Creole, Italian, Korean, and Russian speakers does not appear to have increased. Consumers who speak languages other than English and Spanish would benefit from a calendar, navigation tools, and videos in other languages. immigrant health 2And improved data on racial and ethnic minority and language groups will be essential to help inform targeted and innovative outreach and engagement strategies to make sure all immigrant communities can benefit fully from the ACA. While it is evident that information may be getting to diverse communities, information on enrollment outcomes is not available. Unfortunately, 31% of enrollees chose not to report their race, and 12% chose not to report their ethnicity, which represents a large gap in our knowledge. HCFANY members like the NYIC and NYLPI will continue to work with NYSOH to identify strategies to improve data collection and to educate health consumers about why sharing racial and ethnic identity information is safe and important.

This is the fourth in a series of blog posts about the NYSOH 2015 Open Enrollment Report.

Pride table

High rates of un-insurance among lesbian, gay, bisexual and transgender (LGBT) people have finally started to drop because of the affordable, nondiscriminatory health coverage options made possible by the Affordable Care Act (ACA). The LGBT uninsured rate fell from 24.2 percent to under 18 percent in the first year of operation of ACA health marketplaces, according to national Gallup surveys. But that was still significantly higher than the 13.2 percent un-insurance rate for the U.S. population as a whole.

That’s why Health Care for All New York is reaching out to uninsured LGBT New Yorkers as they participate in Pride celebrations in June and July. Raising Women’s Voices-NY, a HCFANY Steering Committee member, will be at every Pride Month celebration in the New York City area, handing out LGBT-specific information, and collecting contact information for uninsured people and connecting them to navigators who specialize in working with LGBT consumers for enrollment assistance.

Big selling points this year are the recent New York State policy announcements requiring health insurers to cover all medically-necessary transgender care. HCFANY’s LGBT Task Force is delighted to see that the New York Department of Financial Services responded to our concerns by issuing a guidance letter covering private health plans. HCFANY is also educating LGBT New Yorkers about the March 2015 partial lifting of transgender exclusions in state Medicaid coverage.

We’re letting LGBT New Yorkers know that if they are getting married, having a baby or experiencing one of a list of “qualifying life events,” they are eligible for a special enrollment period to apply for coverage through the NY State of Health marketplace. Low-income LGBT people can apply for Medicaid or Children’s Health Insurance Program coverage for themselves and their families year-round. The third open enrollment period for ACA health coverage starts on November 15.Pride outreach

RWV-NY Community Organizer Liza Lederer and summer intern Christianna Silva were at the Brooklyn Pride festivities on June 13, handing out materials and talking with uninsured LGBT people about how to get covered. More than 10,000 people attended Brooklyn Pride, which occupied six blocks in Park Slope Community. Many of the vendors at the festival were self-employed people interested in getting health insurance for the first time, reported Lederer. The following day, June 14, RWV-NY participated in Rockland Pride, which was held in the village of Nyack, and was attended by more than 2,000 people from the Rockland LGBT community.


Coming up on Saturday, June 27, will be Harlem Pride, where RWV-NY staff will do outreach to uninsured LGBT people in the neighborhood. Then, on Sunday, June 28, is the big Pride Festival in Manhattan, which draws more than 200,000 people from around the country. RWV-NY staff and volunteers will be leafleting and collecting names of uninsured people along the parade route and in the exhibit and vendor area that stretches over five blocks in the West Village. Pride activities in the New York City area will conclude on July 17, when RWV-NY will have a table at Bronx Pride, which will be held from noon to 8 p.m. in Crotona Park.