As you may know, Medicaid is the US government health care safety net program for low-income Americans. While both the federal government and each state government contribute funds, the states make the decisions on allocation of those funds. Some states may cover procedures that other states don’t. And since transgender Americans are more likely to be low-income than their cisgender counterparts–nearly four times as likely to have household income under $10,000/year compared to the general population; 27% of trans persons surveyed make less than $20,000/year–many rely on Medicaid for their healthcare. This is especially true for trans persons of color.
Over in Wisconsin, two Wisconsin residents who are transgender are suing the state for the right to have Medicaid cover their gender confirmation treatments (AKA transition). One of the transgender patients also has cerebral palsy, while the other has had to take out loans to cover some procedures but cannot get a large enough loan to cover the remaining procedure. Both already have hormone treatments covered by Medicaid.
Cody Flack, left, and Sara Ann Mackenzie, right, are suing the state of Wisconsin for Medicaid coverage of gender confirmation treatment.
Since a 1997 law in Wisconsin, surgical gender confirmation treatment has been considered on the same level as tattoo removal or ear-lobe repair after damage due to jewelry: purely cosmetic/elective and not medically necessary. However, while few physicians would argue tattoo removal is medically necesary, many will argue that transition is medically necessary for reasons including that it is a treatment for gender dysphoria and that it dramatically reduces suicidality in transgender persons. In particular, these two patients’ physicians have deemed the procedures medically necesary. This lawsuit alleges that the exclusion of the surgery for transgender patients “flies in the face of the medical consensus that gender-confirming medical care is the only safe and effective medical treatment for gender dysphoria, and wholly disregards the harms of denying transgender people access to critical and often life-saving care.”
Wisconsin is amongst the ten (along with Alaska, Wyoming, Nebraska, Iowa, Missouri, Tennessee, Georgia, Ohio, and Maine) of the US’s fifty states whose Medicaid programs do not cover such procedures. Eighteen states cover the procedures explicitly, and another 22 have no clear policy. While the Obama administration had interpreted Section 1557 of the Affordable Care Act prohibiting discrimination on the basis of sex and gender to include transgender persons, the Trump administration has explicitly rejected this interpretation and is rolling back these protections as seen in Health and Human Services’ current explanation of 1557.
You can read more about the Wisconsin case at the Milwaukee Journal-Sentinel, The Blaze, and Into.
