General Assembly expands Medicaid coverage for gender-affirming care

ANNAPOLIS — The House of Delegates on Thursday voted to expand Medicaid coverage for gender-affirming treatments, sending the measure to Gov. Wes Moore to sign into law, which he has said he intends to do.

Gender-affirming treatments, according to the bill, help people align their body or appearance with their gender identity and alleviate distress from gender dysphoria, which can occur when the sex someone was assigned at birth doesn’t align with their gender identity.

The treatments can include hormone therapy, hormone or puberty blockers and changes to parts of the body, including the face, chest or genitals.

Maryland Medicaid, which helps with health care costs for people younger than 65 with incomes below a certain threshold, currently covers some gender-affirming treatments for people ages 18 and older who have been diagnosed with gender dysphoria, including outpatient psychotherapy or mental health services, hormone replacement therapy, gender reassignment surgery, procedures for people transitioning from one gender to another and post-transition services.

The Trans Health Equity Act requires that, beginning Jan. 1, 2024, Maryland Medicaid will also cover processes for people changing their hair, voice and certain physical features, fertility preservation services and the reversal of prior treatments — though there is an “extremely low prevalence of regret” in transgender people following transition surgeries, according to the Maryland Department of Health.

The new treatments included in the bill can range from less than $800 for voice therapy or lessons to more than $25,000 for some surgeries and procedures, according to the Maryland Department of Health.

Before the House of Delegates cast its 93-39 favorable vote Thursday, Republicans proposed changes to the bill, including one that would’ve prohibited a physician from “performing irreversible gender reassignment surgery” on children younger than 18. The Democrat-led House voted down the amendments.

“We as legislators cannot insert ourselves into the health decisions that families are making,” said Del. Bonnie Cullison, D-Montgomery, one of the sponsors of the bill.

Last year, Maryland was one of 23 states where Medicaid covered gender-affirming care, according to a report from the Williams Institute at the University of California, Los Angeles.

Of the roughly 24,000 transgender adults in Maryland, one in four were enrolled in Medicaid last year, the Williams Institute’s report states.

Nearly 100 people received gender-affirming treatment through Medicaid last year, according to bill documents.

The Maryland Department of Health has advised lawmakers that, with the passing of the Trans Health Equity Act, the number of people enrolled in Medicaid who seek gender-affirming treatment will increase by 25 each year.

Friday is the International Transgender Day of Visibility, which is meant to raise awareness of the discrimination that transgender, nonbinary and gender-nonconforming people face and highlight their contributions to society.

Moore is scheduled to host transgender community members and advocates at the Maryland State House to recognize the International Transgender Day of Visibility.

The House vote came one day after state lawmakers in Kentucky overrode Democratic Gov. Andy Beshear’s veto of a bill to ban young people’s access to gender-affirming care and restricting which bathrooms transgender youths can use, among other measures, according to a report from the Associated Press.

Kentucky lawmakers had introduced the bill weeks after the transgender son of one of their colleagues, Democratic state Sen. Karen Berg, died by suicide.

The Human Rights Campaign, a national LGBTQ+ advocacy organization, has condemned legislators and governors in Kentucky, West Virginia, Texas, Indiana and Idaho who this week voted for or signed into law bills that would restrict access to gender-affirming care.

Maddie Deutsch, president of the United States Professional Association for Transgender Health and a professor of family and community medicine, said in a statement earlier this month that, “Legislation that bans gender-affirming care is frequently based on misinformation and false statements meant to stir unfounded fears resulting in harmful and baseless laws about what happens between a doctor and their patient.”