Patrick A. Paschall, executive director of FreeState Legal and Equality Maryland, applauded the Maryland Insurance Administration. (Photo courtesy Patrick Paschall)

FreeState Legal and Equality Maryland announced on Wednesday that the Maryland Insurance Administration has issued bulletins prohibiting individual, small-group, and student health insurance plans sold in Maryland from excluding coverage for health care for the purpose of gender transition. This announcement follows longstanding advocacy by FreeState Legal and Equality Maryland, most recently including a request to the federal Center for Consumer Information and Insurance Oversight asking federal regulators to require Maryland to prohibit transition-related care exclusions from appearing in these state-regulated insurance plans that are governed by the federal Affordable Care Act.

“We applaud the Maryland Insurance Administration for prohibiting this discriminatory exclusion that has become a fixture in health insurance plans and that does significant harm to the transgender community,” said Patrick A. Paschall, executive director of FreeState Legal and Equality Maryland.

“Transition-related care exclusions serve no other purpose than to discriminate against transgender people. To deny life-saving medical care to an entire population based solely on the fact that they identify as transgender is not only unconscionable, but we believe a violation of federal law. We are glad that the Maryland Insurance Administration agrees that transition-related care exclusions violate federal law and has taken action to ensure that the individual, small-group, and student plans it regulates no longer discriminate on the basis of gender identity.”

The Maryland Insurance Administration bulletins, issued on Dec. 7 and 10, 2015, inform health insurers that transition-related care exclusions will no longer be permitted as the agency reviews and approves individual and small-group health plans for the 2017 plan year and student health plans for the 2016-17 school year. The bulletins require carriers to update their plans, and clarify that the requirement applies to plans that are sold either through the ACA exchange or off the exchange.

The administration based its decision on an existing federal regulation, 45 CFR § 156.200(e), issued in 2012, that prohibits discrimination in qualified health plans on the basis of personal characteristics such as gender identity. In the recent bulletins, the Maryland Insurance Administration ruled that transition-related care exclusions can no longer appear in small-group, individual, and student plans because “federal guidance has determined that this type of exclusion is a discriminatory benefit design,” prohibited by the federal regulation.

“We hope this sends a clear message to insurers that denial of transition-related health care solely because the patient is transgender is unlawfully discriminatory, and that the federal regulations on which the agency based its decision are currently in effect,” said Paschall. “We believe that discrimination against transgender people in all health insurance plans is against the law, and we at FreeState Legal and Equality Maryland will continue to bring legal action against insurers that discriminate and employers that choose discriminatory plans. We will not stop until all transgender people in Maryland have full and equal access to the health care they need.”

This action has been applauded by advocates for gender identity equality. “Maryland state regulations continue to fall into line with the civil rights code from the Affordable Care Act,” Dana Beyer, executive director of Gender Rights Maryland, told the Blade. “Thanks to Free State Legal and its dogged and skillful pursuit of these benefits for Maryland residents!”