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N.Y. Advises Insurers To Cover Gender Dysphoria Treatments

December 15, 2014 — New York's Department of Financial Services on Thursday released guidelines advising commercial health insurers in the state to cover medically necessary treatments related to gender dysphoria, the AP/NBC New York reports.

The department noted that gender dysphoria is classified as a mental health disorder in the latest edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Lisette Johnson, head of the department's Health Bureau, wrote in the guidance, "An issuer of a policy that includes coverage for mental health conditions may not exclude coverage for the diagnosis and treatment of gender dysphoria."

Impact

State DFS Superintendent Ben Lawsky said the guidelines send the message to insurers that discriminating against transgender individuals by denying health care will not be tolerated.

According to the Transgender Legal Defense and Education Fund, New York is the ninth state to issue such guidance -- following California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont and Washington -- and the District of Columbia also has a similar policy. In addition, the federal government in May ended a policy that barred coverage of gender affirmation surgery under Medicare.

Meanwhile, the fund called on New York to also remove the exclusion of such treatments from its Medicaid program. TLDEF Executive Director Michael Silverman said, "Transgender Medicaid recipients are some of New York's most vulnerable citizens. They must be able to access medically necessary care."

New York Health Plan Association spokesperson Leslie Moran noted that some larger health insurers already cover treatment related to gender dysphoria if it is deemed medically necessary. She said insurers are concerned the guidelines will spur an increase in claims for such services, which could add costs next year that were not accounted for in rates that have already been approved by state regulators.

However, state DFS spokesperson Matt Anderson said Thursday that officials do not expect the guidance "to have a material impact on overall premiums" (Virtanen, AP/NBC New York, 12/11).