Progressive healthcare providers say recent HHS rules banning discrimination against transgender people raise more questions about how to adequately serve that community.
Previously, civil rights laws enforced by HHS' Office for Civil Rights were based specifically on race, color, national origin, disability and age. The recent rules clarify that civil rights protections will further block discrimination based on sex, which the agency says includes gender identity.
The rules apply to any provider or program that accepts federal dollars and carries out the anti-bias provisions of the Affordable Care Act.
Insurers will not be required to cover gender transition treatments like surgery. But they could face questions if they deny medically necessary services related to gender transition.
In larger states, like California and New York, which have relatively stringent anti-discrimination laws, industry stakeholders say they need more guidance for discrimination gray areas.
For instance, if a male to female individual shares a hospital room with a woman and that person still looks noticeably male, the hospital cannot answer any questions about the person's gender, since that's private medical information, said Lois Richardson, an attorney and vice president at the California Hospital Association.
In regards to coverage, health plans in New York State are already required to cover medical necessary procedures for transgendered individuals. Still, the state's providers have questions.
“Especially regarding teenagers,” said Leslie Moran, a senior vice president with the New York Health Plan Association, “(At) what age do you start reimbursing for hormone therapy, for instance?”
The new anti-discrimination rules are expected to cost the healthcare industry, as well as state and federal agencies, $558 million in training and administrative costs over its first few years of implementation, the agency estimates.
But many in the LGBT community say it's worth it.
“This will help reduce rates of depression, suicide and substance abuse among transgender people, as well as alleviate stress-related health conditions that all people have when they aren't getting the care they need,” Mara Keisling, executive director of the National Center for Transgender Equality, said in a statement.
The Office of Civil Rights says that despite numerous official anti-discriminatory policies and laws, they still receive 3,000 complaints a year.
The proposed rules are open for public comment through Nov. 6.
