Transgender people across the country face discrimination and other barriers to care which can make it difficult to achieve their health care goals. These barriers are there for New Yorkers, too, and came up during a HCFANY-led focus group looking into how LGBTQ+ New Yorkers are affected by medical debt. Participants described high medical bills after coverage denials for gender-affirming care – despite plans covering these same procedures, like hormone therapy, for cis patients. The discussion also found that LGBTQ+ New Yorkers are still paying out-of-pocket for surprise bills, even as they should be protected under New York’s Surprise Bill Law.
LGBTQ+ New Yorkers should know that they can get support from the State and from advocates if they experience discrimination in the health care system. New York State requires coverage for all gender-affirming treatment and last year required NYS-regulated insurance carriers to develop evidence-based medical necessity criteria for gender-affirming care. All plans are required to submit their criteria to the State for approval and in June the State announced that carriers are complying with the requirements. This is important because it means medical necessity decisions are more standardized and if anything goes wrong, plan members have documentation of what the plan was supposed to do. Until the State required it, many plans had no written policies on gender-affirming care. When they did, their policies didn’t always match medical best practices and categorized necessary treatments as cosmetic.
In its “Health Coverage Information for Transgender New Yorkers” guide, the state describes the process for appealing denials or filing complaints with the state when your rights have been violated. You can also get help from programs like the Community Health Advocates. They can help you no matter what type of insurance you have. Fighting to get health care you need can be exhausting and painful – if you want help, you don’t have to take on the entire burden by yourself.
CHA advocates can also help with the surprise bills that so many focus group participants described. These billing problems included bills that are clearly covered under New York’s Surprise Bill law and receiving multiple bills of varying amounts for one service. One participant received a medical bill that was so unclear she could not find contact information to pay it, even after multiple calls to the hospital where she received care. Another described conversations with their providers’ billing office as feeling “like a tennis ball being bounced around different courts.”
New York should continue to monitor insurance policies on gender-affirming care and ensure that plans who violate coverage requirements are held accountable. It should also make sure that consumer assistance programs like CHA are fully funded so that patients have support dealing with unclear and unfair medical bills.
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.
Guest post by Jessica Pierson, graduate student intern with Raising Women’s Voices-NY.
National Women’s Health Week kicked off on Mother’s Day and will continue through Saturday, May 19th. Raising Women’s Voices-NY is celebrating by hosting activities and providing resources to promote women’s health throughout the week.
On Tuesday, May 15th, Raising Women’s Voices is hosting a Twitter Chat from 2 to 3 p.m. to discuss women’s health using the hashtag, #HerHealth. Organizations from around the country will be sharing information on a range of women’s health topics, such as what to expect at a well-woman visit, black maternal health disparities, how to take advantage of cost-free preventive services, reproductive health care for trans folks and how to navigate the health care system.
National Women’s Health Week is a great time to remind women to schedule their annual well-woman visit, which is free with their health insurance. RWV has created a flyer outlining key women’s preventive services for health organizations to use in promoting National Women’s Health Week. Navigating the health system can be difficult and confusing. RWV’s flyer can help simplify women’s experiences with the health system by explaining that services such as birth control, STI/HIV testing, blood pressure tests, flu shots and help quitting smoking are all included in a free well-women’s visit! The flyer also explains how to schedule an appointment, what to expect at the appointment and how to get the most out of the visit. RWV suggests distributing these customizable flyers at bus stops, laundromats or other local spots in order to reach women in every corner of your community.
Looking to promote women’s health in your area? RWV suggests amplifying National Women’s Health week by hosting an open house or community care night, holding a panel discussion or press events.
The Affordable Care Act improved access to women’s health services, but still millions of women are uninsured. Although Open Enrollment for health insurance through NY State of Health doesn’t start again until November, women may qualify for a Special Enrollment Period of 60 days if they experience a qualifying life event. Examples include losing your job-based health insurance, getting married, having a baby, adopting a child or, in New York only, becoming pregnant. Medicaid, Essential Plan, and Child Health Plus enrollment continue year-round. If you think you might qualify for enrollment, contact the Community Health Advocates hotline at 888-614-5400.
It is imperative that we celebrate National Women’s Health Week by helping women get insured and utilize their insurance wisely to optimize their health and well-being, and catch health problems early. RWV hopes you will join us for our Twitter Chat on May 15 and help us promote women’s health all week long!
In the midst of the chaos being caused by the most recent effort to repeal and replace the Affordable Care Act, there is another very important program at risk: the Children’s Health Insurance Program (CHIP). CHIP covers more than 9 million children nationwide and more than 630,000 in New York State alone. Without Congressional action, federal funding for CHIP will expire on September 30 of this year. New York will exhaust its share of CHIP funds in March 2018.
But there is some good news! This morning, the Senate Finance Committee released a bill that would extend federal funding for CHIP for an additional five years – through 2022. The bill keeps the additional federal matching funds (or “the 23% bump”) for states through 2019. The bill would also extend other provisions of CHIP such as:
- Child Enrollment Contingency Fund – this is for states that predict a CHIP funding shortfall because of higher than expected enrollment
- Qualifying State Option – this is a rule that allows states to use CHIP funding to pay for the difference between Medicaid and CHIP reimbursement to providers who care for higher-income children in Medicaid expansion versions of CHIP
- Express Lane Eligibility – this option allows states to use eligibility for other public programs to make eligibility determinations for CHIP. This makes it much easier for kids to get covered!
- Affordability Standards – Premiums for CHIP cannot cost more than 5 percent of income for families earning less than 300 % of the Federal Poverty Level
New York’s kids and children across the country who rely on CHIP need this bill to make it across the finish line. Please join HCFANY for a webinar on Thursday, September 21 at 2PM to hear from Judith Arnold, Director, Division of Eligibility and Marketplace Integration at the New York State Department of Health, and some of our advocates here at HCFANY on CHIP, what it means for New York, and how you can get involved.
Check out HCFANY’s latest fact sheet on CHIP here.