These two states require coverage of this nature and are telling insurers to stop denying healthcare.
California and Oregon regulators have now issued a relatively quiet directive to some health insurance companies in order to have them cease their policies for denying coverage to transgender patients due to the nature of their gender identities.
Insurers in these states aren’t required to provide specific medical treatments but cannot deny healthcare.
The regulators in California and Oregon have now instructed some private health insurance companies that they cannot deny the claims for a transgender policyholder’s breast reduction, hormone therapy, cancer screening, or any other medically necessary procedure, should those procedures be covered for policyholders who are not transgender.
The changes will affect many of the large health insurance companies in those states.
It will apply to the health insurance companies covering approximately 7 percent of policyholders in California, and insurers covering around one third of the customers in Oregon. That said, this does not apply to the individuals receiving Medicaid or Medicare coverage, nor to most Californians who have their coverage through an HMO.
Consumer advocacy groups have applauded the move by the regulators in the two states, saying that it is a considerable step forward in a long and ongoing struggle to achieve improved health insurance coverage for American patients who are transgender.
Health insurance officials from both states have explained that the new regulations aren’t a form of new policy, but are instead designed to clarify laws for anti-discrimination which were passed in California in 2005 and in Oregon in 2007. These laws were already in existence, but the new regulations are now being issued to help to better support and refine them within a more practical context.
It is common for health insurance policies to provide a general coverage for gender identity disorders or to apply pre-existing classifications to them. Many transgender residents of those states find themselves being denied coverage for medical procedures despite the fact that are not connected to a gender transition. According to advocacy groups, this is because insurers have labeled the condition requiring treatment to be in some way connected to the sex reassignment.