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Illinois Medicaid now covering transgender therapy

Illinois Medicaid now covering transgender therapy

Rules require physician letters and prior approval

By PETER HANCOCK
Capitol News Illinois
phancock@capitolnewsillinois.com

SPRINGFIELD – The Illinois Medicaid program now covers medical procedures for people transitioning from one gender to another.

The Department of Healthcare and Family Services, the state’s primary Medicaid agency, published new administrative rules that spell out the types of “gender-affirming” services covered and the conditions under which the program will reimburse providers for those services. The rules became effective Dec. 23.

The department announced in April that it would develop such a policy. Previously, Illinois specifically excluded what had been referred to as “transsexual surgery” from Medicaid coverage.

“Health care is a right, not a privilege, and I’m committed to ensuring our LGBTQ community and all Illinoisans have access to that right,” Gov. J.B. Pritzker said in a statement at the time. “Expanding Medicaid to cover gender affirming surgeries is cost effective, helps avoid long-term health consequences, and most importantly is the right thing to do. With continued attacks coming from Washington, this administration will always stand with our transgender community and their right to lead safe and healthy lives.”

The procedures are available to people diagnosed with gender dysphoria, a recognized condition in which people experience distress or discomfort because the gender they were assigned at birth does not match the gender with which they identify. Researchers say it occurs in only a small percentage of all individuals.

Under Illinois’ new policy, coverage is available to people over age 21, although it can be provided to some people younger than 21 if it’s determined to be medically necessary.

Procedures covered include genital surgery as well as breast or chest surgery. To qualify for genital surgery, a patient must submit letters from two qualified medical practitioners, including the patient’s primary care provider, who have each examined the patient independently. Non-genital surgery requires only one letter from the primary care provider or a gender-related care physician.

To qualify for genital surgery, patients first must undergo hormone therapy, unless they are medically unable to do so. They also must have lived for at least the past 12 months in the gender role to which they are transitioning.

According to the advocacy group Movement Advancement Project, 20 states, including Illinois, and the District of Columbia now cover gender affirmation procedures in their Medicaid programs. Nine states explicitly exclude that coverage. The others have no specific policy.

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