Momentum building around access to care in the transgender community: Part 2

Posted June, 18 2014 by Amanda


Guest post by Milo Primeaux, Health Counselor at Community Service Society of NY and HCFANY LGBT Task Force Member

This post continues our two-part blog about recent changes at the state and federal levels that will improve access to health care for the transgender community. In Part I, we looked at how a recent change to Medicare policy paves the way for better access to transition-related services for transgender individuals. Now in Part II, we’ll look at how a recent change in state policy makes it easier for transgender New Yorkers to access official documents that reflect their identities.

The New York State Department of Health announced on June 5, 2014 that surgery would no longer be required to change gender on state-issued birth certificates! This means that many transgender New Yorkers can now more easily amend their official identity documents to accurately reflect who they know themselves to be. The new policy requires an individual to submit a certification from a licensed medical provider stating that the applicant is undergoing “appropriate clinical treatment.”

New York State’s policy change places it among only a few other states and several federal agencies with similarly progressive policies. It also came just days before the American Medical Association adopted a new policy that calls upon governments to remove surgical requirements from any and all policies related to gender-marker changes on birth certificates. It is important to note that this policy change does not affect New York City birth certificates, which are issued by a local department of health.

Official identity documents such as birth certificates, driver’s licenses, Social Security cards, passports, work IDs, and student records, among others, play an integral role in our every day lives – a fact often taken for granted by people whose IDs readily match who they are. For transgender people this frequently not the case. A transgender person – someone whose sex at birth is different from who they know themselves to be on the inside – may need to amend their official identity documents to accurately reflect their lived gender identity. When official documents do not reflect a transgender person’s lived experience, this contributes to experiences of discrimination, harassment, and violence in all aspects of a transgender person’s life, such as housing, employment, healthcare access, immigration, law enforcement, and ability to marry, among others. For more on this, take a look at Injustice at Every Turn, the most comprehensive report published on transgender discrimination.

So what holds folks back from making the necessary changes? The short answer is simple: bad policies. To this day most states either:

(a)    have strict requirements of evidence before changes can be made (usually, this includes proof of sterilizing surgeries);

(b)   altogether prohibit gender-marker changes on birth certificates and driver’s licenses; or

(c)    do not have any clear policy or process, thus leaving the determination entirely in the hands of the government employee or judge considering the request.

Until this recent policy change, New York State fell into the first category, requiring applicants to submit physicians’ statements, surgical and psychological reports, and proof of receiving hormone replacement therapy. Among the required surgeries were those that effectively sterilized the transgender New Yorker. Even after the three-month process, there was no guarantee that the gender-marker change would be approved.

Issues around a transgender person’s right to their reproductive integrity and medical privacy aside for the moment (as they are substantial enough to deserve their own blog posts), such evidentiary requirements are problematic because they fail to take into account that surgery is not medically necessary or appropriate for every transgender person. Furthermore most private and public insurance plans explicitly prohibit coverage of these “required” treatments (see Part I of this series), and many transgender people cannot afford to pay out of pocket for the procedures.

That’s why this recent decision is so important to the health and wellbeing of many transgender New Yorkers. We hope that New York City and other states will follow suit as momentum continues to build around transgender healthcare access.


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