The state of Connecticut wants to make things absolutely clear when it comes to residents seeking medical treatment, psychological counseling and other related services. No one will be denied medically necessary care because of race, creed or sexual orientation.
As of Dec. 19, 2013, the latter group now specifically includes transgendered individuals. A bulletin issued by the Connecticut Department of Insurance prohibits insurance companies from withholding treatment “because of the individual’s gender identity or expression.”
It mandates that “health insurers are required to pay covered expenses for treatment provided to individuals with gender dysphoria where the treatment is deemed necessary under generally accepted medical standards.”
Treatment can include gender reassignment surgery, hormonal therapy and psychological counseling.
“The climate in Connecticut is always very open-minded and there’s always a hunger for education about issues and understanding individual situations,” says Anne Melissa Dowling, deputy commissioner of the Connecticut Insurance Department.
Since 2011, Connecticut laws have prohibited discrimination against transgendered individuals. How these laws apply to medical insurance coverage and the definition of “medically necessary” treatments – especially with regard to the transgender population – were not explicitly stated. As a result, many transgendered individuals were denied insurance coverage for treatment.
In order to provide a more equitable application of existing laws, a clarification was necessary. Inquiries by local and national constituents, including Gay & Lesbian Advocates and Defenders (GLAD), prompted the Connecticut Insurance Department to carefully re-examine the 2011 legislation.
The December 2013 bulletin eliminated any of the possible ambiguities. Insurance carriers were notified that ignoring the bulletin would not be tolerated, and that non-compliance would result in reprimands and possible fines. “Any treatments, medical, surgical or mental health, as long as they are deemed medically necessary, need to be covered,” says Dowling.
Anthony Crisci, executive director of Triangle Community Center in Norwalk, Conn., is extremely encouraged by the recent course of events. “They had to clarify the insurance regulations and [explain] exactly what they meant,” Crisci says.
“It not only means that you can’t discriminate but you have to include transgender-inclusive policies that serve the unique needs of the transgendered community.”
(It should be noted that the Connecticut Insurance Department’s jurisdiction does not apply to self-funded employer plans, which cover roughly half of Connecticut employees. For self-funded plans, generally used by municipalities or very large companies, compliance is voluntary).
Kellan Baker, MPH, associate director of the Center for American Progress in Washington, D.C., feels that that ongoing education and outreach are essential for change. It is important, he says, for people to develop “an awareness of what transgendered people are and what they need.”
Baker, a leading national advocate for transgender issues, sees discrimination against transgendered individuals in every area of their lives, “from education and employment to housing and healthcare. There is also an extraordinary prevalence of suicide attempts in the transgender population.”
He has worked with several states to draft similar insurance bulletins. “There is a lot that already exists in the law,” explains Baker, “and it’s part of a trend of clarifying what we mean when we say discrimination on the basis of gender identity or against transgendered people.”
On April 22, 2013, the Vermont Department of Financial Regulation, Division of Insurance, issued a bulletin promoting equality of care for transgendered individuals.
“A lot of things are aligning,” notes Samuel Lurie, Ed.M., a longtime advocate in Vermont for transgender rights. “You have state policies that say discrimination is illegal. Then you have clarification from the commissioner of insurance which says that insurance companies cannot discriminate.
“You’ve got the Affordable Care Act, which says that insurance companies cannot discriminate. Now you need to have insurance companies actually follow the law and that still seems to be where there’s a gap.”
In addition to Connecticut and Vermont, Maryland, California, Colorado, Oregon and Washington, D.C. have also issued insurance bulletins mandating coverage for transgendered individuals.
“There have been a lot of incredible advocates working on the state, local and national levels, says Baker. “They’ve achieved an amazing amount of change in a very short period of time.”