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Submit Comments to Strengthen Healthcare for Transgender New Yorkers!

As we let you know earlier this month, transgender New Yorkers who use Medicaid received tremendous life-affirming news in the last ruling in the Cruz v. Zucker case. This is a case that SRLP and our allies at the Legal Aid Society and Willkie Farr & Gallagher LLC brought to challenge the decades long ban on accessing gender-affirming healthcare for low-income trans New Yorkers.

We are now in the process of fighting for the very best regulation to ensure consistent, quality access to this life-saving care. Therefore, we are calling on all of you yet again to assist us in submitting comments regarding the most recent amendment to the existing regulation improving access to this healthcare. While the Department of Health (DOH) has heard from our plaintiffs and from experts on the importance of this healthcare, we want to make sure the DOH continues to hear from trans and gender non-conforming people, our advocates, and allies on the importance of access to medical care.

There are two main ways to take action:

  1. Come by SRLP tonight, Wednesday November 16 from 5:30-7:30pm to join others in submitting comments and learning about this process. You can RSVP here.
  2. Use the text below as a template for your own comments and send an email to Katherine Ceroalo, Department of Health at regsqna@health.ny.gov.

The deadline to submit comments to the Department of Health is Monday, November 21st, 2016. 

In Solidarity,

Mik Kinkead
Staff Attorney

Katherine Ceroalo
New York State Department of Health, Bureau of House Counsel
Regulatory Affairs Unit
Room 2438, ESP Tower Building
Albany, NY 12237

RE:     Proposed Amendment to section 505.2(l) of Title 18 NYCRR

To Whom It May Concern:

 My name is _________________________________ and I submit these comments in response to the proposed amendments to 18 N.Y.C.R.R. § 505.2(l) in support of the expansion of coverage and to recommend changes to promote greater access to transgender health care. I support DOH unambiguously providing Medicaid coverage for medically necessary health care to treat Gender Dysphoria (GD) for individuals of all ages, especially in light of final judgment being entered in Cruz v Zucker on claims related to the exclusions in 18 N.Y.C.R.R. § 505.2(l) that deny Medicaid coverage for GD treatment for individuals under age 18.

I am submitting the below comments in the event that DOH still intends to publish and implement the proposed amendments to the regulation .

These updates matter to me greatly because ___________________________________.

I strongly support the following changes to the regulation:

  • The expansion of coverage for pubertal suppressants and cross-sex hormones for individuals of all ages who find this life-saving treatment medically necessary.
  • The inclusion of licensed clinical social workers in the list of licensed New York State health professionals who can provide a letter referring a transgender New Yorker for affirming services.
  • I am glad to see that the amended regulations continue to honor the fact that hormone replacement therapy may be medically counter-indicated for many individuals and that hormone replacement therapy is not part of every individual’s transition. I would like to see this acknowledgement of self-determination of gender identity highlighted even more in the regulation.

I am very concerned; however, that the proposed amendment continues to use inaccessible language that I worry will result in denials of care for many eligible transgender people. For example:

  • The proposed amendment contains a definition of “cosmetic services” that is different than the definition used elsewhere. The same definition should apply to all individuals using Medicaid services. There is no reason to include this exclusionary language in the regulation itself as it links our necessary health care treatment to the concept of cosmetic services which, I believe, will continue to invite incorrect denials of care.
  • I also urge DOH to consider more accessible language when discussing the medical necessity of breast augmentation surgeries. Currently the regulation says that a person must have “negligible” breast growth following 24 months of hormone therapy. The term negligible implies that the individuals has somehow failed to have the appropriate growth needed, and I am worried that this term shifts the burden onto a transgender person as opposed to affirming the need for many individuals to access this health care. In addition, negligible is undefined and I worry about insurance companies using this vague language against transgender New Yorkers.
  • Finally, in addition to the five-year review mandated by State Administrative Procedures Act 207(1), I urge DOH to continue to review medical consensus and any changing opinions of leading medical professional organizations such as the Endocrine Society or the World Professional Association for Transgender Health that may occur.

I appreciate the opportunity to submit these comments to strengthen access to healthcare for transgender Medicaid recipients. Access to health care is vital to the stability and strength of any community. I therefore urge DOH to strengthen the regulation as suggested above.

Respectfully Submitted,

___________________