Colorado has received approval from the Biden administration to add gender-affirming care coverage in its essential health benefits packages in Affordable Care Act exchange plans. The Centers for Medicare & Medicaid Services (CMS) said this is in line with the White House’s broader goal of reducing health disparities, in this case by removing barriers to transgender individuals receiving care.
- New approach: According to CMS, Colorado’s strategy avoids a “one-size-fits-all” approach to transgender care and would give access to a wider spectrum of services than many people presently have. Eye and lid alterations, facial tightening, facial bone remodeling for facial feminization, breast and/or chest construction and reduction, and laser hair removal will all be possible treatments
- Accessible: “Health care should be accessible, affordable, and delivered equitably to all, regardless of your sexual orientation. To truly break down barriers to care, we must expand access to the full scope of health care, including gender-affirming surgery and other treatments, for people who rely on coverage through Medicare, Medicaid & CHIP and the Marketplaces,” said CMS Administrator Chiquita Brooks-LaSure in a statement.
- Services: Preventive and wellness services, chronic disease management, maternity, and newborn care, hospitalization, prescription drugs, mental health, and substance use disorder services, behavioral health treatment, and lab services are all required to be covered by qualified health plans offered on the exchanges under the Affordable Care Act.
- Recommended care: “Health care should be in reach for everyone; by guaranteeing transgender individuals can access recommended care, we’re one step closer to making this a reality,” Department of Health and Human Services Secretary Xavier Becerra said in a statement. “I am proud to stand with Colorado to remove barriers that have historically made it difficult for transgender people to access health coverage and medical care.”
- Beginning: The changes go into effect in 2023 and apply only to individual and small-group plans.”We hope this marks a historic beginning, and that other states look to Colorado as a model,” Chiquita Brooks-LaSure said. “We invite other states to follow suit.”