The state Department of Health and Human Services is finalizing new regulations to ensure trans Medicaid recipients are provided medically necessary transition services.
The new regulations are the outcome of a federal antibias suit filed by “John Doe,” a trans Medicaid recipient denied a medically necessary hysterectomy.
The lawsuit, filed in February, officially ended July 15 by order of U.S. District Judge J. Curtis Joyner.
Services covered by the state include gender-confirmation surgery, hysterectomy, hormonal therapy, breast reconstruction, penectomy, vaginoplasty, mastectomy, vaginal dilation and release of labial adhesions.
The state began covering such services in May, when the Doe case was tentatively settled, said Julie Chovanes, Doe’s attorney.
Last week, Doe had a hysterectomy and he’s doing well, Chovanes said, adding he “is pleased and excited that his lawsuit brought justice to so many trans people across the commonwealth.”
Gov. Wolf issued this statement about the new coverage:
“I applaud the Department of Human Services for their commitment to ensuring all people are receiving the medical care they need. While this is a step forward for Pennsylvania, we still have work to do. Pennsylvania is the only state in the northeast United States that does not have legislation to prohibit LGBT discrimination. This fundamental right is essential, and enjoys broad, bipartisan support.”
Kathaleen Gillis, a DHS spokesperson, said the new coverage is consistent with federal antibias regulations.
“[DHS] is committed to providing all Pennsylvanians with access to high-quality services, and we prohibit discrimination on the basis of race, color, national origin, sex, age or disability in our health-care programs,” Gillis said in an email. “DHS has worked with advocates, stakeholders and consumers to develop the framework for which prior authorization review for gender-confirmation services will be delivered in accordance with federal regulations.”
She said the new state regulations are expected to be published in October. “Regulations have not been published at this time. DHS anticipates publication in October 2016,” Gillis said. “They will be published in the Pennsylvania Bulletin, the Commonwealth’s official gazette.”
The regulations will be submitted to the state Independent Regulatory Review Commission and the state Attorney General’s Office for review, Gillis added, noting this “regulation package will merely strike the existing language, which currently prohibits payment for gender-transition services in Pennsylvania’s Medical Assistance Program.”