This issue brief from the Center for American Progress describes the importance of nondiscrimination in health insurance coverage based on gender identity, and of ensuring the availability of medically-necessary health care services for transgender people. As health insurance exchanges are being established and implemented, it is vital that “essential health benefits” from “qualified health plans” include medically necessary, comprehensive health care services for transgender people. Ensuring these services would be consistent with section 1557 of the Patient Protection and Affordable Care Act prohibiting discrimination on demographic characteristics, including gender identity, and section 1302, which prohibits discrimination on the basis of disability or medical condition.
Unfortunately, the “benchmark” health plans that are being used to define these essential health benefits in each state have specific exclusions for medically necessary transgender-related health care services in at least 15 states. Information on the benchmark health plans in the remaining states is not yet available.
The issue brief outlines recommended steps for the federal and state governments to prohibit this discrimination based on gender identity.