Sue Bonner, right, with Gender Justice League director Danni Askini. Photo by Casey Jaywork

State Medicaid Rule Changes Could Restrict Transgender Healthcare Access, Say Advocates

The rule changes are still under consideration by the Health Care Authority.

Access to health care for transgender people has improved dramatically over the past several years, in part due to Obamacare’s expansion of Medicaid. Now, the Washington State Health Care Authority, which over sees the program, is weighing rule changes that could tighten access to treatment for trans patients, specifically in cases where Medicaid covers the cost of gender transitional treatments.

Under the proposal, Medicaid would continue to cover the most major gender transitional operations, such as chest and groin surgeries, and many other medical procedures as a treatment for gender dysphoria—the medical condition in which there’s a painful mismatch between one’s lived gender versus one’s body. However, it would no longer cover some associated treatments such as liposuction, trachea shave, or drugs for hair loss or growth, among other things.

Transgender advocates argue the rule changes are arbitrary, and target trans people. A patient and their doctor, they say, should be the final arbiters when it comes to patient health.

The rules “create an unnecessary burden that singles out transgender people, who are the only people as a group who experience gender dysphoria, for differential treatment” from other ailments, Danni Askini, director of Gender Justice League, said at a public hearing in Olympia on Tuesday about the rule change. “This is contrary to law.”

The “list of covered and noncovered services are actually quite arbitrary and capricious,” said Askini. “They are not based on a rigorous scientific methodology that is based on research.” Askini noted that gender dysphoria works differently for different people, and the standards of care for treating the condition are meant to be tailored to a patient’s specific needs, not rigidly forced onto all patients equally.

We previously wrote about one transgender man’s experience navigating the bureaucratic obstacles trans people face when seeking surgery under Medicaid. The new rules, Askini says, would make getting gender dysphoria treatment an even bigger paperwork nightmare than it is now. Along with reducing the number of procedures covered, the new rule would make people jump through more hoops before getting the remaining procedures covered.

The proposed rule changes would “reduce the flexibility that providers are currently entitled to under the rules by making a series of checklists, essentially, that are inflexible,” says Askini. Specifically, the proposed changes would add language saying that patients seeking gender surgery must first complete “all of the presurgical requirements” that are already laid out in the rules in detail. Askini says that this will create less flexibility for doctors to waive those requirements for patients who may not want or need all of them.

HCA spokesperson Amy Blondin was present at Tuesday’s hearing. She says that the proposed changes are not meant to cut off anyone’s access. “The intent of the rules is to provide more clarity and to make sure that the care team decides on the treatment,” she says. There is an appeal process in which patients can pursue if their treatment is rejected by the HCA. “The intent is not to limit any services, but to leave it up to the treatment providers to make those decisions in partnership with the patient.”

Askini agrees with the need to clarify what’s covered, but wants that clarity to broaden access for gender dysphoric patients, not restrict them. As things stand, she says, it’s heard of for doctors to prescribe treatments that are then rejected for payment by the HCA. “It is one reason few providers take Apple Health,” she says, referring to the brand name of Washington’s Medicaid program.

The HCA is listening to the public feedback it’s getting from Askini and others, says Blondin. “Obviously we have a public comment process for a reason,” she says, “which is to hear from people who have concerns…We are absolutely taking all of those into account.”

cjaywork@seattleweekly.com

More in News & Comment

Bob Ferguson is going after controversial Trump administration policies once again. Photo by Joe Mabel/Wikimedia Commons
AG Ferguson Takes on Trump’s Immigrant Family Separation

Washington’s Attorney General plans to sue the federal government over the “zero tolerance” policy.

Since he first ran for the King County Prosecutor’s Office in 2007, Dan Satterberg has never faced an electoral challenger. Photo courtesy Dan Satterberg
The Political Invulnerability of King County Prosecutor Dan Satterberg

He hasn’t faced an electoral challenge since taking office. Does his new longshot social justice-minded challenger stand a chance?

Aneelah Afzali, executive director of American Muslim Empowerment Network, was the featured speaker at 21 Progress’s Rise #7 event. Photo by Melissa Hellmann
How a Local Muslim Activist Is Bridging the Faith Divide to Foster Hope

As part of 21 Progress’ Rise series, Aneelah Afzali drew parallels between anti-Muslim rhetoric and immigration xenophobia.

After Seattle’s controversial employee head tax was repealed, King County Executive Dow Constantine wants to bond against existing tax revenues to generate $100 million for affordable housing. Photo by Joe Mabel/Wikipedia Commons
County Executive Proposes $100 Million Affordable Housing Bond

The money was already coming, but Constantine wants to speed up the process.

The exterior of the University District crisis pregnancy center, 3W Medical for Women. Photo by Keiko DeLuca
How Title X Cuts Impact UW Women’s Health

Some student advocates worry that slashed budgets could drive student to misleading crisis pregnancy centers.

Trans Pride Seattle seeks to strengthen the transgender and non-binary community. 
Photo courtesy of Gender Justice League
Trans Pride Seattle Continues Marching

In light of federal budget cuts, the parade that highlights marginalized voices survives due to community crowdfunding.

As the executive director of the Tenants Union of Washington State, Violet Lavatai (left) believes that YIMBY policies 
do not actually help the communities most in need of housing. Photo courtesy Tenants Union of Washington State
The Growing Power of Seattle YIMBYs

The tech-funded “Yes in My Backyard” movement thinks the housing crisis can be solved by rapid development, but does it only benefit those at the top?

Hidden River Farms is 100 acres of farmland in Grays Harbor County. Photo by Lucia Wyss
Sowing the Seeds of Mental Health

Suicide is an epidemic amongst agricultural workers, but young farmers and state legislators are working to find solutions.

Most Read