In light of recent changes in federal policy, Senator Mary L. Washington (D-Baltimore) and Dr. Anne R. Kaiser (D-Mongomery) have adopted a Medicaid policy surrounding transgender Marylander medical care. We are requesting the Ministry of Health to redesign.
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In light of recent changes in federal policy, Senator Mary L. Washington (D-Baltimore) and Dr. Anne R. Kaiser (D-Mongomery) have adopted a Medicaid policy surrounding transgender Marylander medical care. We are requesting the Ministry of Health to redesign.
Washington and Kaiser told Maryland Health Director Dennis R. Schrader in early April that the state was at risk of being accused of violating the indiscriminate provisions of the Affordable Care Act. This is because the current policy contains only a small part of the steps to verify gender and includes a long list of exclusions and criteria that must be met in order to receive the service of interest. Because it is.
“We urge the department to develop new policies defined by clinical best practices in providing gender-affirming healthcare to transgender people, in line with legal requirements. “They write.
On a phone call Friday afternoon, Washington said the letter was her way of ensuring that she had “due diligence in exploring all the paths to accomplish this.”
“”[I] I wanted the legislature not needed, “Washington said.
During the 2022 legislative session, Kaiser and Washington co-sponsored a bill to expand the coverage of medical services that identify genders available to people with private insurance for Medicaid beneficiaries.
The bill passed the Senate, but appeared to disappear after a vote by the House Health and Government Steering Committee.
Tricia Roddy, Deputy Medicaid Director of the Ministry of Health, responded to Washington and Kaiser this week, stating that authorities will not revise the policy.
“”[W]We will continue to consider new federal developments as needed, but MDH has determined that there is no need to change the coverage of the existing Medicaid, Maryland at this time, “Lodi wrote Wednesday.
In April, the US Department of Health and Social Welfare announced that it would interpret the anti-discrimination provisions of the Affordable Care Act to include a ban on discrimination based on gender identity and sexual orientation.
According to Washington and Kaiser, federal agencies are helping transgender patients file discrimination complaints to demand compliance from the state. They warned Schroeder that the state was at risk of proceedings for not providing the benefits of care to confirm proper gender through Medicare and Medicaid plans.
They also said the Ministry of Health could face discrimination proceedings from civilians under its own law.
“Maryland can’t afford to wait any longer for the ministry to update its policy,” Washington and Kaiser wrote.
“Original target and discrimination”
Under the policy of the Maryland Medical Assistance Program, organizations under the state’s Medicade system will provide specific transgender medical services such as outpatient mental health services to treat gender identity, hormone replacement therapy, laboratory services, and sex reassignment surgery. Wants to cover.
To qualify a patient for sex reassignment surgery, he must prove that he has suffered from persistent gender identity disorder for at least two years.
According to the Mayo Clinic, gender identity is a feeling of serious distress for people whose gender identity is different from the gender they were assigned at birth.
Patient discomfort should not be the result of another mental illness. However, under Maryland policy, dysphoria must be severe enough to cause “clinically significant distress” or impair an individual’s ability to function in a social or work environment.
If you are suffering from another clinical mental health disorder, such as bipolar disorder, dissociative identity disorder, or borderline personality disorder, take medication or psychotherapy to the patient before the doctor approves the gender-verifying surgery. I need to receive therapy.
The patient is then required to be evaluated by a qualified mental health professional and receive two signed letters. At least one of them must have a PhD.
These letters indicate that the patient has been on hormone replacement therapy for at least one year and, if possible, should elaborate on the period presented as gender.
If the patient wants a mastectomy, he only needs one letter and does not need to receive continuous hormone replacement therapy.
Breast augmentation surgery is covered only if the hormone prescribing physician documents that the patient’s breast size still causes severe psychological distress, even after one year of hormone replacement therapy.
Maryland’s medical plan is needed to cover sex reassignment surgery, but there are also other services such as facial reconstruction, hair loss, and voice changes, as well as a second phase of female-to-male genital reconstruction surgery. Not covered.
Many of these exclusions are inconsistent with the standards of care recommended by the World Transgender Health Professionals Association.
“These exclusions are uniquely targeted and discriminated against transgender individuals,” Washington and Kaiser wrote. “Therefore, the policy is not compliant with state and federal law.”
Lodi said the health sector has compared existing policies with those of other states and has reviewed the care standards of the World Transgender Health Professionals Association.
“Exclusion of category”
Outside of their claim that the state’s current policies are discriminatory, Washington and Kaiser say it violates federal Medicaid law.
Under federal law, the services provided under a medical plan must be “amount, duration, and scope sufficient to reasonably achieve its purpose” and “amount of service required,” The duration, or scope, cannot be arbitrarily denied or reduced … simply a diagnosis, type of illness, or condition. “
According to lawmakers, Maryland’s Medicaid program “makes clear exclusions for gender-verifying care” and “cannot provide adequate treatment.”
It also states that this policy violates Maryland rules. This rule requires managed care organizations to provide services and information that address “the individual needs of registrants, regardless of gender, sexual orientation, or gender identity.”
In addition, Washington and Kaiser alleged that the state violated not only sex reassignment surgery, but also regulations requiring care organizations to provide the necessary treatment to members suffering from gender identity disorder.
Lodi said the state’s Medicaid program would provide “medically necessary post-transition services.”
“… Gender-verifying care for existing Maryland Medicaids has access to medical care for transgender and non-binary Marylanders within the scope of federal presidential directives from the legal authorities of the Medicaid Program and President Biden. I will provide, “she writes.
