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.
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.