TLDEF Applauds New York on Continued Efforts to Improve Transgender Health Care


Medicaid PlaintiffsState Clarifies Medicaid Coverage to Ensure that Medically Necessary Procedures Affecting Appearance are Covered

July 1, 2015 - TLDEF applauds New York State for continuing the expansion of transgender health care in its Medicaid program. New policy guidance clarifies that medically necessary care affecting an individual’s appearance must be covered. Such care, which includes facial reconstructive surgery, hair transplantation, electrolysis, and other procedures affecting appearance, is often excluded from health insurance coverage as “cosmetic.” But for many transgender people, such care is medically necessary for the treatment of gender dysphoria, the diagnostic term used to refer to discomfort or distress caused by a difference between a person’s gender identity and their sex assigned at birth.

Earlier this year, New York ended the 17-year-old blanket exclusion of transgender health care from its Medicaid program. But it appeared to continue to exclude procedures affecting appearance by categorically defining them as “cosmetic,” without regard to whether they were undertaken for the treatment of gender dysphoria. TLDEF urged the state to remove all restrictions for medically necessary transgender health care and praises this updated guidance.

Statement from TLDEF Executive Director Michael Silverman

“We strongly commend New York for clarifying that medically necessary procedures affecting appearance must be covered by Medicaid as part of transgender health care. This will improve the lives of transgender people covered by Medicaid by providing them with the vital care they need.

“For many transgender people, medical care intended to bring their appearance in line with who they are is vital to sustaining their health and well-being. Access to these treatments is a lifeline for the vulnerable transgender people who rely upon Medicaid for health care.

“We thank the Cuomo Administration for listening to advocates’ recommendations for improving Medicaid and taking this positive step.”