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In a first, Colorado gets CMS approval to make gender-affirming care an essential health benefit

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The Centers for Medicare & Medicaid Services has approved a request to make gender-affirming care an essential health benefit in Colorado.

For the first time, CMS has approved a state request for mandating that all individual and small group health plans in the Affordable Care Act insurance markets provide a range of gender-affirming care. The plans must offer this care as a health benefit beginning Jan. 1, 2023.

Colorado’s new Essential Health Benefit benchmark plan – that is, the plan that defines the necessary health benefits to be included in all small group and individual plans — will enable transgender individuals to access a wide range of services, including eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions and laser hair removal.

Further, the state is adding mental wellness exams and expanded coverage for 14 prescription drug classes to the benchmark plan.

“To truly break down barriers to care, we must expand access to the full scope of healthcare, including gender-affirming surgery and other treatments, for people who rely on coverage through Medicare, Medicaid & CHIP and the Marketplaces,” said CMS Administrator Chiquita Brooks-LaSure, in a news release. “Colorado’s expansion of their essential health benefits to include gender-affirming surgery and other treatments is a model for other states to follow and we invite other states to follow suit.”

Several prominent healthcare organizations, including the American Medical Association, American Academy of Pediatrics and American Psychiatric Association, recognize gender-affirming healthcare services as a standard level of care.

Despite this recognition from industry groups, 28% of transgender individuals reported postponing or avoiding necessary medical care in 2019, including 22% of transgender respondents of color, for fear of experiencing discrimination, according to a survey conducted last year by the Center for American Progress.

Further, nearly one in two transgender respondents, including 68% of transgender respondents of color, reported experiencing some form of discrimination or mistreatment at the hands of a health provider, including care refusal, misgendering and verbal or physical abuse, survey results show.

“Healthcare should be in reach for everyone; by guaranteeing transgender individuals can access recommended care, we’re one step closer to making this a reality,” said Department of Health and Human Services Secretary Xavier Becerra, in a news release.

Photo credit: Sasirin Pamai, Getty Images

 

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