For the first time, the
"Health care should be in reach for everyone; by guaranteeing transgender individuals can access recommended care, we're one step closer to making this a reality," said HHS Secretary
"Health care should be accessible, affordable and delivered equitably to all, regardless of your sexual orientation. To truly break down barriers to care, we must expand access to the full scope of health care, including gender-affirming surgery and other treatments, for people who rely on coverage through Medicare, Medicaid & CHIP and the Marketplaces," said CMS Administrator
Gender-affirming care is considered a standard level of care by the
The Affordable Care Act (ACA) requires non-grandfathered health plans in the individual and small group markets to provide coverage in 10 categories of EHBs, including preventive and wellness services, chronic disease management, maternity and newborn care, hospitalization, prescription drugs, mental health and substance use disorder services, behavioral health treatment, and lab services. CMS regulations allow states the flexibility to develop state-specific "benchmark" plans that detail the specific services covered among these broad categories based on a typical employer plan offered in the state.
CMS recognizes that expanded, gender-affirming coverage vastly improves health care outcomes for the LGBTQ+ community, reduces high rates of depression, anxiety, and suicide attempts as well as decreases substance use, improves HIV medication adherence, and reduces rates of harmful self-prescribed hormone use.