DHHS Hearing on Transgender Medicaid Access Shows Overwhelming Support for Removing Discriminatory Barriers to Care September 14, 2017

Yesterday evening, a New Hampshire Department of Health and Human Services (DHHS) committee met to discuss adding gender affirmation surgery coverage to our state’s Medicaid program. The committee collected testimony and will make a final recommendation in the coming weeks.

Right now, Medicaid rules prohibit coverage of gender affirmation surgery, even though it is essential care for many of the transgender people who are among the 180,000 Granite Staters covered by Medicaid.

But fair-minded Granite Staters understand that Medicaid patients deserve to have the health care they need determined by a doctor—not political maneuvering or bureaucratic rules. That’s why at yesterday’s hearing, twice as many people testified in favor of lifting the prohibition as testified against it.

Transgender Granite Staters were front and center.

Lisa Bunker, a local author, spoke passionately about her personal experience and how gender affirmation surgery dramatically transformed her life for the better.

Mikayla Bourque, who chairs the SEIU’s 1984 Lavender Caucus, highlighted her 26 years of work as a public servant, and how being able to receive essential health care had allowed her to in turn care for her community.

And Toni Maviki, an LGBT educator and consultant from Danbury, spoke about the urgent need to decrease transgender suicides. Ensuring that transgender people can receive comprehensive medical care drastically reduces this risk of suicide, she said.

Lisa Hall, who serves as the Medical Services Coordinator at the Equality Health Center in Concord, was among those who testified. The health center is a prominent provider of health services for transgender people, and as such, Lisa sees on a daily basis the positive impact on transgender people when they can access gender-affirming care without barriers.

“What our clinic sees is an affirmation of what scientific evidence-based research informs us: Individuals who are able to access these critical medical services are in a better position to lead healthier, more productive lives, contributing more to their communities and society at large.”

She also addressed a common concern: Cost. She says that many insurers worry that covering a comprehensive range of transgender health care services creates a financial burden. But, she says—citing a study from The Williams Institute—that’s just not true. It actually lowers the cost of treating transgender people, since such care allows them to take better care of themselves and and makes it less likely they’ll suffer more serious medical problems.

“What our clinic sees is an affirmation of what scientific evidence-based research informs us: Individuals who are able to access these critical medical services are in a better position to lead healthier, more productive lives, contributing more to their communities and society at large.”—Lisa Hall, Medical Services Coordinator at the Equality Health Center in Concord

Another medical professional who spoke was Dr. Paul Cote, a licensed psychologist, gender specialist and member of the World Professional Association for Transgender Health. He urged decision makers to change the rule in order to conform New Hampshire’s Medicaid program to generally accepted standards of care.

Dawn McKinney, the policy director with New Hampshire Legal Assistance (NHLA), testified to the legal implications of failing to change the Medicaid prohibition on gender affirmation surgery. This coverage, she says, is actually mandated by the Affordable Care Act. 

“Medicaid coverage includes hospital and physician services, such as those required by a Medicaid beneficiary in medical need of gender transition services,” she testified. “Under the nondiscrimination section of the Affordable Care Act, Section 1557, Medicaid cannot discriminate against individuals who need medical care for gender transition.”

“Medicaid coverage includes hospital and physician services, such as those required by a Medicaid beneficiary in medical need of gender transition services,” she testified. “Under the nondiscrimination section of the Affordable Care Act, Section 1557, Medicaid cannot discriminate against individuals who need medical care for gender transition.”—Dawn McKinney, Policy Director with New Hampshire Legal Assistance

Failing to remove the prohibition could theoretically open the state to legal action if someone is denied coverage. Devon Chaffee, Executive Director of the New Hampshire ACLU, and Janson Wu, Executive Director of GLAD, also spoke to this current exclusion under Medicaid violating both state and federal law.

Freedom New Hampshire would like to thank everyone who came to the hearing yesterday to support this much-needed rule change. However, yesterday’s meeting isn’t the end of the road. DHHS will make its recommendation in the coming weeks, and depending on the outcome, we will provide an update from there.