As we enter this Pride weekend it is important to remember that many people – in particular transgender women of color – still struggle to meet their basic human needs such as health care. Despite ongoing litigation in Cruz v. Zucker, the NYS DOH continues to suggest amendments to the current regulation that make it harder for transgender New Yorkers on Medicaid to access comparable care to their cisgender peers on Medicaid or transgender people on private insurance.
Please help us tell the NYS DOH that we need comprehensive health care for all ages and for all of our medical needs. By submitting a comment to the NYS DOH, you are helping to ensure that our health care needs are seen as real and important as they are.
Below is some sample text you may wish to use. Feel free to use this exactly, modify it to fit your story, or write something totally of your own choosing. You can read the proposed amendment here and there is more information on the lawsuit SRLP is bringing with our friends at Legal Aid Society and Willkie Farr and Gallagher here.
Remember to please submit your comments via email to REGSQNA@health.ny.gov by 5pm on Monday June 27!
June 27, 2016
Katherine E. Ceroalo
NYS Department of Health
Bureau of House Counsel, Regulatory Affairs Unit
Corning Tower Building, Rm 2438
Empire State Plaza
Albany, NY 12237
RE: Proposed Amendment to section 505.2(l) of Title 18 NYCRR
Dear Ms. Ceroalo,
My name is ___________________ and I submit these comments as I believe that the proposed amendment to section 505.2(l) of Title 18 NYCRR fails to address the true comprehensive health care needs of transgender New Yorkers. The proposed amendments continue disparate treatment of individuals with gender dysphoria (GD) by creating a presumption of non-coverage for care and by barring all coverage for transgender youth. The New York State Department of Health (DOH) must cover all medically necessary transgender health care for adult and young Medicaid recipients. It is essential that DOH re-evaluate this proposed rule for the following reasons.
First, gender-affirming treatment is medically necessary care, not cosmetic. In the current proposed amendment contains a list in subsection 5. All of the procedures there require the individual seeking health care to overcome a presumption that the services are “cosmetic” and therefore not covered. The procedures that are listed in subsection 5 are known to be highly effective and medically necessary to alleviate GD symptoms.
This presumption appears to be unique to trans healthcare. It imposes a higher standard for transgender individuals than for any other Medicaid recipients who are seeking the same procedures but not to address gender dysphoria. This suggests that transgender people’s medical needs are somehow inherently suspect and unbelievable, which I believe is discriminatory and contrary to law.
The amendments also continue to define “cosmetic procedures” differently for patients with GD than for other individuals on Medicaid. For patients with GD, “cosmetic procedures” are those that “are performed solely for the purpose of improving an individual’s appearance,” whereas for patients with other conditions “cosmetic” services are those that “are provided only because of the enrollee’s personal preference.” This distinction is critical and inherently suspect as it applies only to one category of people. Defining “cosmetic procedures” for patients with GD as “improving an individual’s appearance” is an invitation to deny coverage that may be essential.
This matters to me in particular because_________(example: I have needed a life-saving surgery and not been able to access it which caused me these kinds of pain OR I have witnessed friends gone for years without access to the healthcare they need which was painful and difficult, etc) _______________
Secondly, youth are entitled to medically necessary health care as prescribed and recommended by their doctors. Federal law requires that New York recipients of any age must have access to medically necessary health care to treat GD. The DOH must provide Medicaid reimbursement for recipients under 18 for any treatments a physician determines to be medically necessary. The proposed amendment, however, fails to correct the regulation’s blanket prohibition on coverage of medically necessary care for those under 18 years old. As it currently stands, New Yorkers on Medicaid must wait until they turn 18 to receive medically necessary health care for their GD.
The proposed amendment continues to bar coverage for any hormone therapy, including pubertal suppressants, for individuals who are under the age of 18. There is no medical or scientific support for this restriction. Current medical research demonstrates that hormone treatment alleviates GD symptoms and allows transgender youth to experience levels of well-being comparable to peers their age. The Endocrine Society, the world’s largest organization devoted to research on hormones and the clinical practice of endocrinology, recommends treating adolescents diagnosed with GD with pubertal suppressants, followed by cross-sex hormones if necessary. The proposed amendment also continues the blanket prohibition on coverage of surgical treatment, even where a treating physician has determined such care to be necessary for an individual patient, which is contrary to federal law. Decisions of the medical necessity for health care must be made between the individual and their health care providers. The proposed amendment continues to keep young New Yorkers from accessing critical health care.
This matters to me in particular because___(example: I have a transgender child and I see how they struggle without access to hormones OR I went through puberty as a transgender person and I remember how hard it was, etc.) _____________________________________________________
What is even more egregious in the blanket ban on care for people under the age of 18 is that use of puberty-suppressing hormones is not new to New York State Medicaid. These hormones have been used for decades to treat multiple conditions including a common diagnosis called precocious puberty. The DOH already provides pubertal suppressants to youth with these other conditions and should do the same for the diagnosis of GD.
Additionally, youth who are on private insurance are guaranteed access to this care under the memo issued by the Department of Financial Services to all private insurance companies doing business in New York on December 14, 2011. This memo prohibited the denial of medically necessary treatment to any patient regardless of age if the denial is based solely on the fact that the treatment is for gender dysphoria. Youth who have access to and are insured by private insurance are therefore entitled to receive all medically necessary care as prescribed by their doctors, including puberty-suppressing hormones, cross-sex hormones, and surgery. This is in stark contrast to low-income youth in New York who, under the current proposed amendment will experience unjustifiable delays in receiving medically necessary care. That the State would endorse such a two-tier system of health care is unacceptable and discriminatory.
In conclusion, access to health care is vital to the stability and strength of any community. We deserve strong health care based upon standards of care that recognize our identities and needs. The current proposed amendment fails to consider the real needs of people under the age of 18 to access life-saving treatment, and continues to assume that many medical interventions are not truly needed for our health and well-being as transgender people. When health care programs can discriminate against transgender people by creating disparate standards for proving medical needs or by simply assuming what health care is needed our community is disenfranchised and harmed. This affects everything from familial stability to employment to stable housing. There can be no question that meaningful access to healthcare for transgender people is life-saving. I therefore urge DOH to strengthen the regulation by removing the restriction on the so-called “cosmetic” services and by providing coverage to transgender youth. There is no excuse for discrimination in health care.
I appreciate the opportunity to submit these comments on behalf of transgender Medicaid recipients. Thank you for your consideration.
[insert name here]