In October 2021, Colorado become the first state in the nation to explicitly include gender-affirming comprehensive care services in its 2023 minimum health coverage reference mutual.
The plan incorporates expanded behavioral health coverage for people gender dysphoriahormone therapies and “exhaustive” surgical interventions, according to Cara Cheeversdirector of the behavioral health program at the Colorado Division of Insurance (DOI).
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Lieutenant Governor Dianne Primavera, Director of the Office of Saving People Money on Health Care, said:
“Today’s announcement means gender-diverse Coloradans can stop guessing how and what gender-affirming benefits are included in their coverage.”
Prior to the approval of this referral plan by the Centers for Medicare and Medicaid (CMS), coverage of gender-affirming care by many insurance companies varied widely. This disparity and variation in coverage could not be confirmed by data due to lack of data collection on sexual orientation or gender identity. Cheevers said:
“If you’re not counted out, it’s really hard to defend and fight for the things you need.”
Colorado has been working to close this gap since 2008, when Senate Bill 08-200 expanded protections against discrimination in public accommodations, including health care, that were specifically based on sexual orientation and gender identity.
Cheevers said it wasn’t until 2017 that all commercial health plans had no specific coverage exclusions for transgender care. Numerous complaints and testimonies from advocacy groups have led to continued work to provide access to care for transgender people, especially transgender youth.
When the state reopened its referral plan in October, it strengthened access to medically necessary treatment for LGBTQA+ communities across all health insurance sectors and processes.
This includes extensive behavioral health care coverage, which Cheevers says is often needed during gender-affirming treatments. The plan also provided coverage for hormone therapy– which includes receiving hormones that better match a person’s gender identity.
The plan also included coverage for more surgeries like superior surgery—breast or breast tissue removal procedure—, facial feminization surgery, or bottom surgery—the procedure to reconstruct the genitals to those of his gender identity.
Cheevers said CMS Administrator Chiquita Brooks-Lasure intends for other states to follow in Colorado’s footsteps and hopes that can eventually happen at the federal level. She said many other states have reached out to the DOI asking how to include gender-affirming care in their next benchmark.
Cheevers said this benchmark expansion will “save lives” and “make lives better.”
“I have a number of friends and colleagues who identify as transgender, and I think, for trans women in particular – who are for the first time from 2023 able to undergo facial feminization surgery – it will have a direct impact on the quality of life.”