Nevada has become the latest state to announce Medicaid will cover sex reassignment surgery for transgender individuals.
A notice posted late last month on the state Medicaid agency's website site outlined a list of surgical procedures that will be covered both going forward and retroactively to Jan. 1.
"Transgender people are likely to be disproportionately represented in Medicaid programs, therefore it's a very significant advancement for transgender health to get Medicaid programs to cover these benefits," said Jody Herman, a scholar at UCLA's Williams Institute, which specializes in LGBT research.
There are now 16 states plus the District of Columbia that have issued Medicaid coverage guidelines for gender transition, according to Arli Christian, state policy counsel at the National Center for Transgender Equality.
Medicaid's willingness to cover sex reassignment surgery is crucial as transgender people tend to have low incomes compared to the general population. A 2016 survey by the National Center for Transgender Equality found that 29% of respondents it interviewed were living in poverty, which is double the poverty rate in the U.S. adult population.
Sex reassignment surgery can cost as much as $50,000 for women transitioning to men, while male-to-female reassignment can be $7,000 to $24,000, transgender advocates say. Studies show that surgery can help boost the emotional and mental well-being of people who struggle with their gender identity.
Medicaid agencies' willingness to cover reassignment surgery differs from other government coverage programs. In 2016, the CMS announced it would not issue a national coverage determination for such surgeries, though local Medicare contractors could choose to cover the procedures.
That same year the Veterans Affairs Department scrapped a proposal to cover the surgeries. Tricare does not cover them either.
The LGBT community has faced some hurdles since President Donald Trump took office. He has called for banning transgender people from serving in the military, and his administration has pulled back Obama-era protections that allowed transgender students to use bathrooms and facilities that corresponded to their gender identity.
HHS under Trump has also announced plans for a religious freedom office which seeks to protect providers from performing procedures that violate their religious beliefs. Transgender advocates worry the office will lead to discrimination in the healthcare space.
But state Medicaid agencies have been a bright spot for the LGBT community. Montana and Colorado in 2017 issued coverage notices for sex reassignment surgeries, and no states have sought to roll back coverage decisions that were already in place, Christian said.
"Medicaid programs across the country provide essential benefits for the health and well-being of some of this country's most vulnerable residents," Christian said. "All people, regardless of transgender status, should have access to medically necessary services."