Now that Massachusetts has protected gender-affirming care, it’s time to make it truly accessible.
Last month, Governor Charlie Baker signed legislation that provides essential protections for abortion care and essential health care for transgender people in the Commonwealth. As gender-affirming care is now legally protected across the state, a momentous task lies ahead: To access to gender-affirming care. Even in Massachusetts, it’s still incredibly rare, and that needs to change.
Often, insurers will require patients to change primary care providers or pediatricians to access services, as they allow patients to be assigned to only one primary care provider. This creates an immediate barrier. Understandably, many patients are unwilling to switch primary care providers, especially if they have an established relationship with their practice; and no one should have to do so to get health care.
In addition to increasing payments for gender-affirming care through MassHealth, the state can also extend care by taking two simple steps. First payers — commercial insurers, responsible care organizations, MassHealth — could provide some services as specialty care. Second, insurers could pay for clinical consultation services. Implementing either of these models would give patients the choice to stay with their primary provider while accessing gender-affirming care.
Under a specialized model, a patient could stay with their primary care provider and obtain services – such as hormone therapy – from another qualified provider. Additionally, many members of the trans and gender-diverse community exhibit high levels of trauma and complex psychological difficulties, and this model would provide increased incentive to provide comprehensive mental health care. And the stakes couldn’t be higher. According to a 2022 survey by the Trevor Project, more than 53% of transgender and gender-diverse youth have considered suicide in the past year, and the most recent National Transgender Survey found that more than 50% of trans adults had attempted suicide.
Under a consultation model, a patient could stay with their primary care provider – and if the provider did not have experience in a specific area, they could consult with an expert who would help provide care. of quality apart from his own experience. There is precedent for this, such as the successful model of the Massachusetts Child Psychiatry Access Program, which was established in 2004. This program is funded by the state budget and helps all frontline providers identify and addressing the mental health and addictions issues of their pregnant women and postpartum patients. A similar program could be developed for gender-affirming care.
This is essential health care that should be integrated into all forms of care. However, recent data shows that there is woefully insufficient access to this vital coverage across the state. If the state is truly committed to protecting all of its patients, it must also think strategically.
MassHealth has led the way in improving access for trans and gender diverse people by releasing medical necessities guidelines to expand coverage and increasing the number of covered services and reimbursement rates for those services. necessary services. It can now do more by allowing gender-affirming providers to be considered specialist providers and to consult when needed.
The Insurance Division oversees commercial insurance and has always been responsive to the needs of the transgender and gender-diverse community. This presents another opportunity for the DOI to encourage insurers to license these or similar models.
Everyone has a unique relationship with their sex. Trans and gender diverse people know this intimately and deserve to live their lives to the fullest. Now is the time for Massachusetts to continue to lead the way and fight for the expansion of access that our communities desperately need.
Dallas Ducar is the Managing Director of Transhealth Northampton. Follow her on Twitter and Instagram @DallasDucar.