January 8, 2021 at 11:37 am EST | by Philip Van Slooten
Northam budget proposal includes Medicaid access to gender-affirming care
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Virginia Gov. Ralph Northam (Washington Blade file photo by Michael Key)

Virginia Gov. Ralph Northam submitted a budget request in December that includes access to gender-affirming care in the state’s Medicaid program.

Northam, a Democrat, introduced Senate Bill 1100, and its companion bill House Bill 1800, on Dec. 16 for the 2021 legislative session that convenes on Jan. 13.

“The four year journey to secure medically necessary, gender-affirming care for all Virginians has been hard fought,” Equality Virginia Executive Director Vee Lamneck told the Washington Blade on Wednesday. “It is a great relief that the governor included this in his budget so that Virginians who are covered by Medicaid will be able to walk into their doctor’s office and get their healthcare needs met.”

In the 750-page budget, the last line of item 313 under Medicaid Program Services states the department “shall modify agency policy manuals to affirm coverage of services related to gender dysphoria for Medicaid members.” If adopted, Virginia will become the 19th state to expressly include coverage for gender-affirming care under their Medicaid program, according to Williams Institute data.

The Williams Institute’s October study of various states’ Medicaid coverage of gender-affirming care estimated 1.4 million U.S. adults identify as transgender and approximately 152,000 of them are Medicaid beneficiaries.

The study found fewer than half of trans beneficiaries have access to gender-affirming care under their state’s law, despite 2016 U.S. Department of Health and Human Services regulations that  Medicaid programs from excluding insurance coverage to gender-affirming care.

“This is an important equity issue,” Northam press secretary Alena Yarmosky told the Virginia Mercury newspaper on Jan. 4. “And a critical part of making our commonwealth welcoming and inclusive of all.”

Maryland and D.C. previously expanded their Medicaid access, noting the inclusive coverage in health department memos and clarifying policy statements.

In 2014, the D.C. Department of Health Care Finance posted “a clarifying statement of policy” to their website noting gender dysphoria treatment was already covered by Medicaid through a prohibition of discriminatory practices and this statement “should not be construed as newly-mandated Medicaid benefits.”

Similarly, in 2016, the Maryland Department of Health sent a memo to Managed Care Organizations to “reinforce” that they were “now responsible for covering medically necessary gender transition services including gender reassignment surgery.”

Virginia’s Medicaid expansion would bring its services in line with those expressly available to trans beneficiaries in other parts of the region.

“This is an important step toward creating a Virginia that includes us all,” Lamneck, who identifies as a non-binary Virginian, said.

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