The Maryland legislature is considering a bill, the Trans Health Equity Act, that would expand coverage of gender-affirming care to residents of Medicaid, the health plan for low-income and disabled people.
Here are some frequently asked questions about billing.
What is Gender-Affirming Nursing?
On Saturday morning, the Maryland House of Delegates passed legislation that would allow transgender, intersex, dual mind and other gender-matched residents enrolled in Medicaid to receive comprehensive gender-affirming care. The Senate also approved the bill on Monday.
Gender-affirming care is an umbrella term used to describe any care provided to a person who is not cisgender — or someone whose gender identity matches their gender at birth — to help them settle into their feel better about your own body. The federal government has designated it an “essential health benefit” under the Affordable Care Act.
Some gender-affirming care is currently covered by Maryland Medicaid. But dozens of procedures — from laser hair removal to voice therapy to more invasive surgeries — aren’t.
In 2022, 98 people sought gender-affirming care on Medicaid. According to a law analysis, that number is expected to increase by another 25 people per year if it becomes law.
The comparatively small number of Marylanders that would be affected by the bill in no way diminishes its importance, said Margo Quinlan, who works with the Mental Health Association of Maryland and is an organizer of the Trans Rights Advocacy Coalition.
“These are matters of life and death in our community,” Quinlan said.
How much will that cost?
With this addition, the impact on the state Medicaid budget is 0.005%, and proponents argue that this is a cost-saving measure because it is likely to prevent the need for further treatment following events such as suicide attempts.
“We don’t expect this bill to open the floodgates,” Ashley Black, lead counsel for the Health and Benefits Equity project at the Public Justice Center in Baltimore, said during the committee’s first hearing on Feb. 14.
Legislative analysts have not put a figure on the potential cost, but wrote that the cost “would increase by an undetermined but likely significant amount” within a few years. Because the percentage of the cost that the federal government pays for gender-affirming services would drop from 90% of the cost to about two-thirds of the cost.
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Information from The Banner
The cost of individual procedures, which analysts reported, ranged from $800 for voice therapy or classes to more than $50,000 for transition from one gender to another. If 125 people received all eligible services, analysts concluded, it would cost the state an additional $7.6 million. If the same group received just some of the eligible services, the additional government cost would be $2.1 million, according to analysts.
Does this apply to minors?
Although much of the debate in both chambers revolved around objections to the idea of invasive surgeries being performed on children, age is not even mentioned in the bill.
In addition, the bill does not change Maryland Medicaid’s existing policy of not treating trans youth. Trans people under the age of 18 are prescribed reversible puberty blockers and hormone treatment. Additionally, all health care decisions for transgender youth in Maryland require parental consent.
The bill was approved by lawmakers in both chambers and is expected to become law later this year.
Similar legislation has been passed in at least nine states, including Virginia and Washington, DC
Quinlan, who has been at the forefront of this fight for years, said this year was a turning point. The Trans Health Equity Act didn’t pass last year, so she’s inspired by the number of supporters it’s had this year.
Now, she said, the Trans Rights Advocacy Coalition can focus on other issues.
“I think we’re going to leave this session in a pretty good place to delve deeper into some of this work,” Quinlan said.