DENVER (AP) — Colorado will include gender confirmation care in its individual and small group health insurancePlans, federal and state officials announce Tuesday.

The state’s plan under the Centers for Medicare & Medicaid Services will include jaw, cheek and eye modifications, face tightening, facial bone remodeling for facial feminization, breast or chest construction and reductions and laser hair removal.

Additional health benefits for Colorado’s plan include an annual mental health exam and expanded coverage of opioid alternatives for pain management, Democratic Gov. Jared Polis spoke out. According to the Colorado Division of Insurance, this plan will include 15 alternative drugs and cover six acupuncture sessions per year. These changes take effect January 1, 2023.

The Centers for Medicare & Medicaid Services, or CMS, approved Colorado’s request to provide gender-confirming care as part of the state’s “essential health benefits,” which are requirements for individual and small employer plans set forth under former President Barack Obama’s Affordable Care Act.

Federal law doesn’t require that states cover gender-confirming healthcare in state Medicaid programs. This allows state policies to vary from prohibiting all types of gender affirming care to having no written policy. This leaves thousands of transgender adults on Medicaid without coverage and causes a “gray area” where individuals have to navigate the plans with their health care providers, said Christy Mallory, legal director at the Williams Institute, a research institute based in the University of California Los Angeles’ School of Law.

Mallory said that without insurance, much of gender confirming care is “prohibitively expensive,” and including these services in insurance plans increases access to medically necessary care for trans people.

“People who need access to this care will not only be healthier because they are getting the care they need through a doctor, through a licensed health care provider, but also that that will have positive impacts on their health overall … as a result of being able to transition and be their full selves,” Mallory said.

The CMS guidelines permit states to set their own coverage requirements, but they must include specific categories like preventive and wellness services and chronic disease management. Prescription drugs and treatment for substance abuse disorders and mental illness, as well as behavioral and laboratory services.

“States can be incredibly interested in what other states do,” Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure said at a news conference Tuesday. “I think that Colorado making this step of going forward and affirming this desire will cause other states to also take a look at their coverage and think about whether to add gender-affirming coverage as well.”

The announcement comes as Republican-led states have enacted several restrictions on transgender people’s rights this year. Arkansas was named the “Best” state. first state to ban gender confirming treatmentsfor transgender young people. West Virginia was just one of many states that had approved transgender athlete restrictions. In June, the Department of Justice declared that transgender athletes were not allowed to compete in public. laws in both states violate the equal protection clause The 14th Amendment.

Georgia was sued by two transgender people in June. They claimed that the state had discriminated against them. denied access to gender-affirming health care under the state’s Medicaid program

The Williams Institute reports that 12 states don’t cover the gender affirming care part of Medicaid, while 20 other states haven’t addressed this issue.

The American Medical Association and American Academy of Family Physicians consider gender-affirming care a standard level of healthcare, according to a federal health department release.

“For too long, too many transgender and nonbinary people have struggled to access the health care they need, despite having health insurance,” said Democratic state Rep. Brianna Titone, one of a handful of elected transgender lawmakers in the U.S. “These services are critical for the health and safety of LGBTQ+ communities and will provide more Coloradans with the agency they need to affirm their identities.”

While insurance companies must cover some form of gender-affirming care, patients’ coverage varies and may exclude certain services even if a health care provider determines it to be medically necessary, the Colorado Division of Insurance said in a statement.

Colorado’s individual and small group health insurance plans cover nearly a quarter of residents in the state, Polis said.

Democratic state Sen. Brittany Pettersen praised the plan’s inclusion of opioid-alternatives as changing a “system that incentivized over-prescribing,” which she attributed to national lobbying by pharmaceutical companies that came down to providers who were given financial incentives.

“This is going to be meaningful for a third of Colorado’s population,” Pettersen said. “When they are going to the doctor, they are going to be able to look at additional options instead of drugs that are oftentimes the cheapest up front but led to devastation later on.”

Brooks-LaSure praised Colorado’s new coverage as part of the Biden administration’s commitment to removing barriers to coverage for LGBTQ+ people.

“Gender-affirming care can be life-saving. By making this care essential, the benchmark plan will guide what is included in health coverage statewide,” Brooks-LaSure said.

The so-called “reinsurance” program, which began in 2019, covers Colorado’s most expensive consumer plans. This allows insurers to reduce their rates. It’s also allowed them to extend their coverage, especially in rural areas where scarce, if any, competition in the past delivered some of the nation’s highest premiums for many regions of Colorado.

New law requires that insurers offer standard, state-supervised plans to small and medium businesses. This will allow residents to save on their health care costs. It is expected to take effect in 2023. The law requires that premiums be reduced by 15% on plans currently offered.

Since 2018, Polis prioritized affordability and access to healthcare.

He DemocratsThe legislators are looking to reduce the cost of prescription drugs, fix inequities that have been exposed in the health system by the coronavirus epidemic, make hospitals price transparent, lower prescription drug prices, limit insulin prices, and boost mental health care care among other things.


Nieberg is a Associated Press/Report for America Statehouse News Initiative corps member. Report for America is an independent national service program which places journalists in newsrooms around the country to cover underreported topics.


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