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D.C. requires insurers to cover gender reassignment

Vincent Gray, transgender, gay news, Washington Blade, gender reassignment

‘Treatment of individuals diagnosed with gender dysphoria is a covered benefit in all individual and group insurance plans in the District of Columbia, including Medicaid,’ said Mayor Vincent Gray. (Washington Blade photo by Michael Key)

D.C. Mayor Vincent Gray announced on Thursday that health insurance companies doing business in the District must provide full coverage for medically recognized treatments to help transgender people change their gender, including gender reassignment surgery.

At a news conference in a meeting room outside his office, Gray said the city’s Department of Insurance, Securities, and Banking issued a bulletin directing insurers to recognize a condition known as gender dysphoria, or gender identity disorder, as a medical condition to be covered by insurance plans.

Transgender advocates note that the American Medical Association and the American Psychiatric Association recognize gender dysphoria as a diagnosable condition through which physicians and other health care professional provide a wide range of approved medical treatments to assist people in transitioning from one gender to another.

“Today, the District takes a major step toward leveling the playing field for individuals diagnosed with gender dysphoria,” Gray said. “These residents should not have to pay exorbitant out-of-pocket expenses for medically necessary treatment when those without gender dysphoria do not,” he said.

“I’m clarifying today that treatment of individuals diagnosed with gender dysphoria is a covered benefit in all individual and group insurance plans in the District of Columbia, including Medicaid,” Gray said.

Gray’s remark drew a prolonged, standing ovation from LGBT activists, including transgender advocates, who gathered in the mayor’s ceremonial bill-signing room where Gray held his news conference.

“Those who know me know how proud I am that the District continues to be on the cutting edge and on the forefront when it relates to equality and fairness for its LGBTQ residents,” Gray said.

The bulletin, which the city sent to insurance companies on the day of Gray’s announcement, cites the D.C. Human Rights Act as among the legal grounds being used to require insurers to cover transgender related treatments. The Human Rights Act, among other categories, bans discrimination based on gender identity and expression as well as sexual orientation.

The bulletin cites the D.C. Unfair Insurance Trade Practices Act of 2001 as further grounds for not allowing insurers to exclude coverage of trans-related treatments from their insurance plans.

Among those speaking at the news conference was Mara Keisling, executive director of the D.C.-based National Center for Transgender Equality, which worked with the mayor’s office and insurance department officials to help draft the four-page bulletin.

Keisling said Gray’s action places D.C. among just five states that have adopted similar policies requiring insurers to cover treatments such as gender reassignment surgery and hormone therapy to assist an individual’s transition to another gender.

Those states are California, Oregon, Colorado, Vermont and Connecticut.

“This is really significant,” Keisling told the Blade after the news conference. “It means that transgender people in D.C. now can make their health care decisions with their doctor rather than with their insurance companies,” she said.

Mara Keisling, NCTE, National Center for Transgender Equality, gay news, Washington Blade

Mara Keisling, executive director of the National Center for Transgender Equality. (Washington Blade photo by Michael Key)

Asked what treatments are involved in a gender transition, Keisling said experts with the World Professional Association for Transgender Health Standards of Care (WPATH) have developed a wide range of treatments that may vary from person to person depending on individual needs.

“It’s a whole range of transition-related care — everything from diagnostic visits to experts in the field,” Keisling said. “It can mean hormone treatments. It can mean lab tests to make sure your hormones are working correctly and not causing any harm. There are various kinds of surgeries that transgender people may need. So it covers a whole range of things.”

D.C. transgender activist Andy Bowen, who recently joined the staff of the NCTE as a policy associate, called the D.C. initiative announced by Gray the most comprehensive among the states that have adopted similar policies.

“If you look at some of the other states they say they’re not going to cover some treatments,” Bowen said. “D.C. has not done that. It just said that if it’s one of the WPATH treatments we’re going to cover it. And that’s amazing to hear a government be that unequivocal about it.”

Philip Barlow, the city’s Associate Commissioner of Insurance, said after the news conference that requiring health insurance companies to cover the medical treatments for transgender people would likely result in a small increase in premiums over a period of time.

“It will just be incorporated into the general cost and utilization that insurers use in coming up with future rate increases,” he said. “But we don’t really anticipate it to have a significant impact on the rates.”

Michael Silverman, executive director of the New York-based Transgender Legal Defense and Education Fund, praised Gray for taking action that he said would “end health care discrimination against transgender residents of Washington, D.C.”

The bulletin issued by the city’s Department of Insurance that directs insurers to provide full coverage for medically approved treatments to transgender individuals in D.C. can be obtained here.

28
Feb
2014

Labor Dept. issues guidance to protect trans workers

Labor Secretary Thomas Perez has issued guidance protecting transgender workers.(Washington Blade file photo by Michael Key)

Labor Secretary Thomas Perez has issued guidance protecting transgender workers. (Washington Blade file photo by Michael Key)

The Labor Department issued guidance on Tuesday spelling out that the Obama administration will interpret an executive order prohibiting gender discrimination in the workforce to protect transgender workers.

The news was announced via White House blog post written by Patricia Shiu, director of the Office of Federal Contract Compliance Programs. It’s titled “Strength in Diversity.”

“It means honoring our commitment to upholding equality in America’s workforce,” Shiu writes. “Being entrusted with taxpayer dollars is a privilege, and with that privilege comes a promise to open doors to all of America’s workers. I believe that success for OFCCP and for federal contractors isn’t simply about compliance. It’s about creating a workplace culture that actively embraces diversity.”

The guidance is based off a 2012 decision by the U.S. Equal Employment Opportunity Commission in the case of Macy v. Holder, which determined that transgender workers are eligible for protections under Title VII of the Civil Rights Act of 1964.

As a result of that decision, the Labor Department indicates in its guidance that it’ll enforce Executive Order 11246 — which prohibits federal contractors from engaging in gender discrimination — to protect against employment bias based on gender identity.

But the guidance wasn’t handed down from the Labor Department until more than two years after the Macy decision. LGBT advocates had pushed the Obama administration to clarify that transgender workers are protected under current policy as Labor Secretary Thomas Perez said the matter was “under review.” In June, Perez announced the review had come to an end and forthcoming guidance would indicate gender identity would be covered under current policy.

Tico Almeida, president of Freedom to Work, commended the Labor Department for issuing the guidance and said companies without explicit protections for transgender workers should update their policies.

“We applaud Labor Secretary Perez and OFCCP Director Shiu for this tremendously important stand in favor of workplace fairness for transgender Americans, and the ball is now in the court of holdout corporations like ExxonMobil and their defense lawyers at Seyfarth Shaw who should convince that corporation that it’s long past time to update their workplace policies,” Almeida said. “Today’s announcement should give Seyfarth Shaw lawyers yet another reason to persuade Exxon to do the right thing.”

Still forthcoming from the Labor Department are regulations to implement the Executive Order 13672, which President Obama signed in July to explicitly spell out that federal contractors are unable to discriminate on the basis of sexual orientation and gender identity. The order is expected to take effect early next year.

Michael Silverman, executive director of the Transgender Legal Defense & Education Fund, also had high praise for the Obama administration for issuing the guidance.

“Everyone should have the same opportunity to earn a living and provide for their families, without fear of being fired simply for being who they are,” Silverman said. “For the many transgender people who work for federal contractors, this brings a great sense of peace in knowing that their job security will be based on performance, and not gender identity.”

19
Aug
2014

Oregon bans anti-trans health care discrimination

Gay News, Washington Blade, Mara Keisling, Transgender

Mara Keisling, executive director of the National Center for Transgender Equality (Washington Blade file photo by Michael Key)

Transgender advocates have applauded new regulations that ban private health insurance companies in Oregon from discriminating against trans policy holders.

The guidelines the Oregon Insurance Division of the state Department of Consumer and Business Services announced on Dec. 19 specifically prohibit health care providers from discriminating against a policy holder based on their actual or perceived gender identity and expression. Under the guidelines, providers cannot deny coverage of hormone therapy, hysterectomies, mastectomies and other medically-necessary treatments for gender dysphoria and sex-reassignment surgery that are covered for non-trans policy holders.

The agency also prohibited insurance companies from denying coverage of a particular treatment simply because the policy holder is trans. The guidelines also expand Oregon’s statewide mandate for mental health services to include trans Oregonians.

Basic Rights Oregon, a statewide LGBT advocacy group, had been working with the agency to expand these protections to trans policy holders since 2009.

Lawmakers in 2007 approved a law that explicitly banned discrimination based on sexual orientation — they defined it to include gender identity and expression, but Basic Rights Oregon had sought clarification from the agency after it received complaints from trans policy holders.

“What this means is that trans Oregonians will have access to basic medically necessary care,” Tash Shatz, trans justice program manager at Basic Rights Oregon, told the Washington Blade on Monday. “It’s a huge victory for the transgender community in Oregon. It really represents a sea change in terms of this issue.”

Michael Silverman, executive director of the Transgender Legal Defense and Education Fund, agreed.

“Oregon has correctly recognized that the well-established medical consensus is that transgender-related health care is medically necessary care,” he said. “This care is designed to treat a recognized medical condition. Transgender individuals pay the same premiums as everyone else and simply want the same benefits.”

The agency released its new guidelines two days after Oregon Health and Science University announced it would cover trans-specific health care. Intel, which is headquartered in Hillsboro, Ore., is among the 25 percent of Fortune 100 companies that currently offer trans-inclusive health care policies to their employees.

The cities of Portland, Seattle and San Francisco and Multnomah County, Ore., also cover trans-specific treatments in their health care plans. The California Department of Insurance has also enacted regulations similar to those in Oregon.

The American Psychiatric Association, the American Psychological Association and the Internal Revenue Service have said trans-specific treatments are medically-necessary care. The American Psychiatric Association on Dec. 2 announced it would remove Gender Identity Disorder from its list of mental disorders and replace it with Gender Dysphoria.

National Center for Transgender Equality Executive Director Mara Keisling told the Blade that colleges and universities, professional agencies and labor unions are among those that continue to advance efforts to ensure health insurance providers cover trans-specific treatments and procedures. She noted the SEIU, which covers full transitionary care for its staff, passed a resolution in May that asked local affiliates to advocate for these benefits in contract negotiations.

“There’s a lot of really, really great advocacy going on in this area right now,” Keisling said. “[What’s] really going on here is just updating these policies now that we have better understanding of medical science, of who trans people are, now we have lots of trans people in the workplace, so we’re going to see more and more of this. This will not be the last state to do that.”

08
Jan
2013