In spite of the Sylvia Rivera Law Project’s victory in ensuring healthcare access for low-income trans, gender non-conforming, and intersex (TGNCI) New Yorkers, and Governor Cuomo’s directive that private insurers allow gender-affirming care, many members of our community continue face barriers to care. From wrongful denials of coverage to red tape to outdated, transphobic policies still being used by insurers, TGNCI people are still encountering discrimination and are being forced to go without life-saving care.
Please join SRLP and our allies in pushing the New York State Department of Health (DOH) and Department of Financial Services (DFS) to take action to address the needs of trans, gender non-conforming, and intersex people. Demand that DOH and DFS issue updated guidances to increase trans people’s access to healthcare, end transphobic discrimination, and enforce their own policies.
Deputy Superintendent for Health
Department of Financial Services
One Commerce Plaza
Albany, NY 12257
NYS Department of Health
Corning Tower, OCP 1211
Albany, NY 12237
RE: Section 505.2(l) of Title 18 NYCRR
Dear Mr. Oechsner and Mr. Helgerson:
I am writing to share my deep concern about a growing trend of health insurance denials for claims related to gender-affirming care.
I appreciate the letter issued by Governor Cuomo and the Department of Financial Services on August 16th, which attempted to clarify insurance coverage for transgender individuals. That letter is a welcome step forward and offers guidance and discourages claims that are denied when the patient’s gender identity supposedly “does not match” the gender of someone who might typically receive those services. While this guidance is helpful, I believe it does not go far enough.
I request that the Department of Financial Services (DFS) as well as the Department of Health (DOH) each issue a letter of guidance summarizing and reiterating all mandates and relevant regulations for issuers regarding public and commercial health insurance coverage for the treatment of gender dysphoria. Additionally, I request that each agency commit to strengthening their enforcement of these important regulations.
As you are aware, in December 2014, guidance was issued by DFS regarding commercial plan coverage. In March 2015, the New York State Medicaid program began covering hormone therapy and gender affirmation surgeries for adults, but still excluded coverage of certain treatments considered “cosmetic”. In early 2016, New York removed restrictions on medically necessary healthcare for transgender Medicaid recipients following an opinion issued by a federal judge in Manhattan. Later in 2016, coverage was expanded for transgender Medicaid recipients under the age of 18.
In recent months, hundreds of transgender individuals in New York State have sought gender affirming healthcare and services and have been wrongfully denied coverage by their health insurance plans. Denials are coming from commercial and Medicaid managed care plans.
Trans and gender non-conforming individuals have faced: plans denying medically necessary procedures because of administrative errors and non-medical policies that violate patients’ dignity and rights; plans developing and using criteria to determine a patient’s eligibility for gender affirming care based on outdated standards of care and not aligned with commonly accepted standards of care; nearly 100% initial denial rate for facial feminization surgery (FFS); and many plans continuing to use transphobic and outdated policies, plans with no policies about transgender care, or plans with policies based on offensive or outdated ideas of gender dysphoria that do not follow standards of care or New York law. Care is denied to transgender and gender non-conforming people but covered for cisgender (non-transgender) people despite New York law saying that discrimination on the basis of gender identity and expression is unlawful. I strongly recommend DFS to intervene, strip these outdated policies, and stop the discriminatory treatment by the commercial plans.
I strongly believe that it is the responsibility of the regulating agencies to ensure that policies of private and public insurance conform to the NYS standards. The process of appealing these denials (whether public or private) causes great confusion for transgender and gender non-conforming people who are trying to obtain treatment and can ultimately decrease their quality of life.
I urge the Department of Financial Services and Department of Health to issue clear, updated guidance and strengthen their enforcement of these policies. This greatly matters to me because
Thank you for your consideration.