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The Fight to Make Medicaid Accessible to TGNC People Continues!

As many SRLP supporters and members know, all transgender and gender non-conforming people in New York State won a huge victory in 2016 for inclusive healthcare when Judge Jed S. Rakoff ruled in our favor in the federal class-action Cruz v. Zucker, which was brought in partnership with the Legal Aid Society and Willkie Farr & Gallagher LLP.

Our last update on this issue was in October 2016 when we shared that Judge Rakoff, presiding justice in Cruz v. Zucker, ruled that the previous Medicaid regulations violated the federal Medicaid Act. Judge Rakoff further held that New York State must provide Medicaid recipients with coverage for all medically necessary treatment and not selectively deny coverage on the basis of diagnosis. Since this ruling, SRLP has joined advocates across the state in tracking denials of healthcare, providing trainings to medical providers, community members, and other attorneys, and assisted in bringing attention to gaps in coverage to the Department of Health.

Our colleagues at the Legal Aid Society (whom we partnered with in bringing Cruz v. Zucker, along with Willkie Farr & Gallagher LLP) were also very busy challenging the denial of healthcare to a non-binary individual. As a result of their amazing advocacy, the Department of Health has issued new guidelines to all Medicaid Managed Care Plans concerning healthcare related to any diagnosis of Gender Dysphoria.

As SRLP commented in our press release, these changes will help curb the often humiliating and degrading practices that transgender and gender non-conforming people have experienced from Medicaid Managed Care Plans over the past few years. As legal documents are (often purposefully) hard to read, we wanted to highlight a few important changes and updates:

  • If a Medicaid Managed Care Plan is to initiate guidance for TGNC care, they must first have its standards cleared by the Department of Health. This will hopefully curtail policies that are clearly unlawful;
  • The guidance clarifies that a person need not identify on the gender binary to access hormones, surgeries, or any other necessary care;
  • Following reports that non-medically licensed insurance reviewers were requesting “photographic proof” of need for surgeries, the guidelines make clear that Medicaid Managed Care Plans must take the treating medical provider’s determination of size, shape, or any other assessment as sufficient proof of medical necessity;
  • Finally, this guidance clarifies that mental health counseling need not be “continuous” for 12 months prior to surgery approval. This is especially helpful for people who do not have access to quality practitioners or whose lives make therapy/counseling very challenging to engage in on a continuous basis.

As we celebrate this important change, it is important to remember all the transgender and gender non-conforming people who reported these practices to local politicians, lawyers, and advocates helping us to track these issues and bring about these changes. This change would not have occurred without people bravely coming forward and discussing some of these horrific and humiliating practices. It is important for us to remember that fearlessness and strength as we celebrate these updates.

SRLP continues to be in coalition with the Legal Aid Society and others as we monitor, analyze, and push these changes forward. If you have questions or concerns about your Medicaid Plan’s treatment of your TGNC-specific healthcare, then please come to our intake drop-in hours every Thursday at the SRLP office from 1-4:30pm. You can read more about our intake hours here.

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