Statehouse Headliners: Despite opposition, Vermont Medicaid funding for youth transgender surgery poised for approval

By Guy Page

A proposed Vermont Medicaid regulation expanding coverage for gender-change surgery to also cover minors will receive final review at a legislative hearing Thursday.

The regulation, rule HCAR 4.238, drew dozens of comments both pro and con during a regulatory process that began May 29.

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Bathroom and locker room problems are only the most visible of transgender issues. The trend toward reassignment surgery for minors is widely considered dangerous, even a form of child abuse.

The Scott administration supports 4.238 because it would “update clinical criteria and expand Medicaid coverage of gender affirmation surgery for the treatment of gender dysphoria when medically necessary and developmentally appropriate, including by allowing individuals under age 21 to access to such services,” Vermont Department of Financial Regulation Commissioner Michael Pieciak wrote in a July 12 letter to the Agency of Human Services Medicaid Policy Unit. “By updating Medicaid coverage requirements, proposed rule HCAR 4.238 would help ensure that medically necessary gender affirmation surgery is available to all Vermonters, whether they are covered by Medicaid or a private insurance policy.”

The University of Vermont Children’s Hospital Youth Transgender Program also praised the new rule because, among other changes, “elimination of age requirement for coverage of surgery.” Vermont Legal Aid said the expansion is actually too restrictive regarding doctor approval and patient accessibility.

Other supporters expressed their views in online comments. So did dozens of opponents of Medicaid-funded transgender surgery for youth. For example:

  • Comment #12: “I am very much OPPOSED to lowering the age or sex reassignment surgery. Children cannot give informed consent to permanent sterilization, lifelong medical patienthood, sexual dysfunction, and a host of psycho-sexual difficulties that will increase their risk of mental illness and suicide, as well as making the possibility of dating and or finding a life partner very slim.”
  • Comment #14: “Transitioning has become a dangerous trend among teens and young adults sold as a cure-all for mental health problems on social media and at schools and colleges. My son fell into this trap but fortunately detransitioned after taking female hormones for three months. He now has permanent breasts and a pituitary gland tumor, both of which may require surgery.”
  • Comment #15 “Please stop this insanity. No child is able to know who they are befpre the age of 25. The average age of desisters is 22. That’s how old they are before they realize their mistake, and the damage is done. Soon parents will be able to hand over newborns to get corrective sex surgery to match what they wanted. Does that sound farfetched? So does an 8-12 year old getting reassignment surgery.”

The review process ends Oct. 4. Legislative Committee on Administrative Rules (LCAR) will meet Thursday, Oct. 3, 10 am, in the Ethan Allen Room of the Vermont State House.

LCAR is a panel of eight legislators – four senators and representatives, chaired by Rep. Robin Chesnut-Tangerman (P-Middletown Springs) – who review proposed state regulations to ensure they follow the letter and spirit of the law on which they are based. Proposed rules must go through a public hearing process before they become final proposed rules reviewed by LCAR. For notices of proposed rules postings, visit the Secretary of State’s Proposed Rules Postings website.

Other upcoming scheduled legislative meetings include:
Single-Use Products Working Group – Tuesday, Oct. 8, 12:30 pm, Room 10, State House.
Legislative Study Committee on Wetlands – 9 am Wednesday, October 9, Room 11, State House.
Task Force on Campus Sexual Harm – 3:30 pm, Wed. Oct. 9, Vermont Room 2nd floor Alliot Student Center, SMC.
Vermont Forest Carbon Sequestration Working Group – Noon, Tuesday, Oct. 15, Room 10, State House.

Statehouse Headliners is intended primarily to educate, not advocate. It is e-mailed to an ever-growing list of interested Vermonters, public officials and media. Guy Page is affiliated with the Vermont Energy Partnership; the Vermont Alliance for Ethical Healthcare; and Physicians, Families and Friends for a Better Vermont.

Images courtesy of Wikimedia Commons/Tim Evanson and Public domain