Studies from Cedars Sinai Medical Center Provide New Data on Hormones (Which Us States’ Medicaid Programs Provide Coverage for Gender-affirming Hormone Therapy and Gender-affirming Genital Surgery for Transgender Patients?: a State-by-state …): Hormones

2022 APR 06 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Researchers detail new data in Hormones. According to news reporting from Los Angeles, California, by NewsRx journalists, research stated, “To date, a comprehensive state-by-state assessment of transgender transition-related health care coverage for gender-affirming hormone therapy (GAHT) and genital gender-affirming surgery (GAS) has not been reported. The aims of this study were 1) to verify which U.S. states’ Medicaid systems do/do not cover GAHT and GAS; 2) to assess the ease/difficulty for patients to determine whether GAHT and GAS are Medicaid-covered benefits; and 3) to understand possible state-related predictors of Medicaid coverage for gender-affirming care.”

The news correspondents obtained a quote from the research from Cedars Sinai Medical Center, “We reviewed the official Medicaid Handbook and website for all 51 states (+D.C.) and 5 territories to confirm whether GAHT and GAS are covered benefits. When indeterminate, we called the Medicaid office in each state, and for many, Medicaid managed care organizations (MCOs), and individual in-state providers, to confirm coverage. We recorded our experiences, number of, and duration of phone calls to confirm coverage. The main outcome was a definitive answer from the state/territory’s Medicaid program or MCOs regarding whether GAHT and GAS are/are not covered benefits. Secondary outcome measures included responses we received and the total number/duration of phone calls necessary to confirm coverage. Only 12 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAHT in their Medicaid Handbook/webpages. We confirmed that 34 of 51 state Medicaid programs do cover GAHT, whereas 9 of 51 states’ and 2 of 5 territories’ do not. We could not confirm coverage of GAHT in 8 of 51 states and 3 of 5 territories. Only 26 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAS in their Medicaid Handbook/webpages. We confirmed that 25 of 51 state Medicaid programs do cover GAS, whereas 22 of 51 states’ and 3 of 5 territories’ do not. We could not confirm coverage of GAS in 4 of 51 states and 2 of 5 territories. Up to 12 calls, lasting up to 125 minutes, were required to confirm coverage for GAHT/GAS. Our findings indicate that important health care access barriers/disparities exist today and warrant improvement. Strengths & Limitations: To our knowledge, this is the most comprehensive assessment of transgender transition-related health care coverage. Limitations include possible bias, as it could be that we were more persistent than actual patients would be to determine service coverage, and a lack of specificity regarding which specific hormone formulations or procedures are/are not covered. Our findings show that only 34 of 51 (67%) states’ Medicaid programs include GAHT and 25 of 51 (49%) include GAS as covered benefits.”

According to the news reporters, the research concluded: “Our experience suggests that the process to confirm coverage can be especially time-consuming and frustrating for patients.”

This research has been peer-reviewed.

For more information on this research see: Which Us States’ Medicaid Programs Provide Coverage for Gender-affirming Hormone Therapy and Gender-affirming Genital Surgery for Transgender Patients?: a State-by-state Review, and a Study Detailing the Patient Experience To Confirm Coverage of Services. The Journal of Sexual Medicine, 2021;18(2):410-422. The Journal of Sexual Medicine can be contacted at: Elsevier Sci Ltd, The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, Oxon, England.

Our news journalists report that additional information may be obtained by contacting Maurice M. Garcia, Cedars Sinai Medical Center, Division of Urology, Los Angeles, CA 90048, United States. Additional authors for this research include Michael Zaliznyak, Eric E. Jung and Catherine Bresee.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1016/j.jsxm.2020.11.016. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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