What Repeal of Medicaid Exclusion Means for Transgender New Yorkers

By Michael Nam


Photo by Shutterstock

Add New York’s Medicaid update to a list of victories for the transgender community.

The state recently took steps to remedy the language that prevented transgender citizens covered by Medicaid from accessing vital healthcare. Governor Andrew Cuomo and the New York Department of Health amended the regulation, according to The Advocate.

The update now permits hormone therapy and gender-reassignment surgery to be covered for the treatment of gender dysphoria. The treatments were explicitly restricted from New York Medicaid coverage in 1998.

“This is a long-overdue move that aligns with action in many other states and in the private sector to recognize transgender people’s health needs as legitimate and in need of appropriate coverage,” Kellan Baker, a Senior Fellow with the LGBT Research and Communications Project at the Center for American Progress, told DiversityInc.

He also noted that the change comes from years of advocacy work done by groups like the Sylvia Rivera Law Project that, recognizing the interplay between discrimination and poverty for transgender people, promote the Medicaid change as an important step “to ensure that transgender people are able to get the healthcare that they need to be happy, healthy and whole.”

However, Sasha Alexander of the Sylvia Rivera Law Project added, “The new regulation doesn’t cover folks under 18, and doesn’t cover surgeries for folks under 21. It also includes no oversight committee, or training for providers who are supposed to implement this regulation. In addition, the regulation refers to lifesaving trans-related medical care as ‘cosmetic,’ which is a dangerous and offensive framing, and disproportionately impacts trans women, meaning the regulation doesn’t cover facial feminization and chest augmentation.”

Among the most marginalized groups in the U.S., the transgender community has particularly suffered from high levels of employment discriminationdespite Justice Department reminders that it is illegaland poverty. According to the paper “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey”:

26 percent reported losing a job due to being transgender or gender nonconforming and 50 percent were harassed

15 percent of transgender respondents experience extreme poverty (wages under $10,000)

34 percent of Black transgender respondents experience extreme poverty

19 percent of transgender or gender nonconforming respondents experience discriminatory denial of healthcare

Updating the Medicaid language to include an underserved segment is a step in alleviating some of this suffering according to the transgender-discrimination survey. The vast majority of respondents “felt more comfortable at work and their job performance improved, despite high levels of mistreatment” when able to transition.

For private companies, an important measure in the DiversityInc Top 50 is LGBT inclusion. The Top 10 Companies for LGBT Employees in 2014 employed multiple best practices such as:

An active LGBT employee resource group

Philanthropic endeavors aimed at LGBT nonprofits

Tracking the number of LGBT people in the workplace, including voluntary disclosure

Featuring images and text of LGBT employees, customers or vendors on the company website

Certifying LGBT vendors with the National Gay & Lesbian Chamber of Commerce

Spending with certified LGBT vendors

Despite issues with the new regulation, the Sylvia Rivera Law Project does state that the change is a “great start” but that it intends to continue pushing for additional reform.

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