Governor Cuomo announced new protections for transgender and gender non-conforming people today in honor of Transgender Day of Remembrance. Transgender and gender non-conforming people live with the burden of violence and discrimination in many parts of their lives, including when they need health care. This discrimination comes from providers, who refuse to provide treatments (whether it’s gender-affirming care or a common cold), and from insurance companies that mischaracterize medically necessary care as cosmetic and refuse to cover it.
New York State’s Department of Financial Services (DFS) has previously prohibited health insurers from excluding gender-affirming care in plans through circular letters and regulations. Despite that prohibition, many transgender or gender non-conforming folks still face barriers accessing gender-affirming care. Procedures like facial feminization and breast augmentation are routinely denied as “cosmetic”, despite the clear and ample medical evidence that such procedures are not cosmetic and have a radical effect in improving quality of life.
As part of the new actions announced today, DFS will codify prohibitions that currently exist as circular letters into regulations. It will work with the Office of Mental Health to review the clinical guidelines plans use to make medical necessity determinations to ensure there are no exclusions for gender-affirming care. It will also work to ensure that external appeal agents, who make decisions when someone appeals an unfair claim with their insurance company, to have experience in transgender health. Finally, DFS will release regulations to clarify that all gender-affirming care is medically necessary to eliminate denials on the basis that the service is cosmetic. New York State will lead by example by ensuring that barriers to gender-affirming care are eliminated from the Empire Plan, which covers over one million government employees.
Are you transgender or gender non-conforming and having trouble accessing health care? Don’t be scared to ask for help! The Community Health Advocates is a free, independent advocacy service that helps people deal with health insurance problems no matter what type of coverage you have – and they’ll even help if you have no coverage! You can make appointments by calling 888-614-5400 no matter where you are in the state.