October 23, 2019
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MaineCare program to cover health services specific to transgender people

Darren Fishell | BDN
Darren Fishell | BDN
The Maine Department of Health and Human Services offices on State Street in Augusta, shown in this December 2017 file photo.

AUGUSTA, Maine — Health care services specific to transgender people are now covered under MaineCare, the state’s version of Medicaid.

The Department of Health and Human Services announced an emergency rule this summer removing transgender-specific health services from the list of procedures MaineCare did not cover. As of Sept. 12, the department finished establishing the criteria for covered services, according to Jackie Farwell, a spokesperson for the department.

Those services include those medically necessary to treat gender dysphoria — a conflict between a person’s gender identity and the gender they were assigned at birth, according to the LGBTQ-rights group EqualityMaine.

Shane Diamond, a spokesperson for the group, said that includes a diagnosis from a mental health provider and hormone-replacement therapy that can bring a person in line with their gender identity. Coverage for surgical procedures related to gender dysphoria will require prior authorization from MaineCare, according to EqualityMaine.

The shift brings the state in line with legislation passed this year and signed by Gov. Janet Mills, a Democrat, clarifying that transgender individuals could not be denied coverage based on their gender identity. A 2017 study from the UCLA School of Law estimated there were between 3,200 and 8,900 transgender adults in Maine.

Maine was one of 10 states to explicitly exclude transgender care in the Medicaid program until this summer in rules dating back to at least 1979, according to the department. The state has strong LGBTQ protections otherwise, according to the Movement Advancement Project.

Diamond said EqualityMaine and the advocacy group Maine TransNet are encouraging health care providers to reach out to the state’s Office of MaineCare Services to understand which billing codes they should use for transgender patients prior to treatment.

 



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