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

The Seattle Coalition for Affordability, Livability and Equity filed an appeal to the Seattle Hearing Examiner on Monday evening. Photo by Melissa Hellmann
Seattle Coalition Appeals Zoning Changes

The 26-group coalition filed an appeal against proposed upzoning that aims to increase housing affordability.

Jenny Durkan Sworn in as Mayor of Seattle

The city’s first female mayor in over a century began her first shift on a citywide tour.

Mastermind of State’s Biggest Ponzi Scheme Escapes From Prison

Frederick Darren Berg had been indicted for fraud in 2012.

Facing Cuts From City, Homeless Service Providers Request a Reprieve

Funding would be cut for at least 300 shelter beds in Seattle, as well as hygiene and support services.

What Has Changed in the Year Since the Passage of Seattle’s Hotel Worker Law?

According to hotel housekeepers on The Westin’s night shift, not much.

Activists and Politicians Rally for Stronger Tenant Protections

During the event, State Representative Nicole Macri announced that she will be introducing legislation to repeal a statewide ban on rent control.

Photo by Frank Kovalchek/Wikimedia
Reports of Assault in the Air Could Be Taking Off

As Randi Zuckerberg accuses Alaska Airlines of inaction, one Seattleite collects accounts of a problem she expects to become more prevalent.

The hummus comes one of five ways. Photo by Nicole Sprinkle
A New Hummus Bar on Capitol Hill Delivers Unexpected Brilliance

A lively atmosphere and fantastic food make Aviv a delectable destination.

Most Read