By Guy Page
A proposed Medicaid insurance coverage rule change would relax some preconditions and remove all age limitations for transgender surgery.
The proposed rule, HCAR 4.238 was published May 29 on the AHS Global Commitment Register: “4.238 Gender Affirmation Surgery for the Treatment of Gender Dysphoria (New) – New rule updates current clinical criteria for Vermont Medicaid to better align with industry clinical guidelines.” It will be reviewed by state regulators following a public hearing and comment period in July.
Regarding age limitation, the proposed new rule would require “documented informed consent, including knowledge of risks, hospitalizations, post-surgical rehabilitation, and compliance of treatment. For minors under 18 years of age, documented informed consent of a parent(s), legal custodian, or guardian is also required unless the minor is emancipated by court order.”
Covered surgeries for transgender purposes would be limited to the following: For genital surgeries: (1) Orchiectomy, (2) Penectomy, (3) Vaginoplasty, (4) Clitoroplasty, (5) Labiaplasty, (6) Hysterectomy, (7) Salpingectomy, (8) Oophorectomy, (9) Salpingo-oophorectomy, (10) Vaginectomy, (11) Prostatectomy, (12) Metoidioplasty, (13) Scrotoplasty, (14) Urethroplasty, (15) Phalloplasty, and (16) Testicular prosthesis. For breast surgeries: (1) Breast augmentation mammoplasty, and (2) Mastectomy.
The rule would reduce the extent of clinical permission and evaluation required for most surgeries, and drops the need to undergo hormonal therapy as a precondition for breast-removal.
A change in transgender surgery insurance coverage appeared to be in the works after Vermont Legal Aid complained Jan. 28 to Agency of Human Services’ Department of Vermont Health Access that that people seeking transgender surgery were being singled out for needing “prior authorization” — that is, their doctor would need to get specific permission to bill for insurance payment. In March, DVHA responded with a denial that the policy is discriminatory, but said it would “address these concerns as the program evolves.”
Another proposed change, 4.207 Prescribed Drugs, would increase the number of Medicaid prescription refills from five to 11. The proposed changes, including expansion of transgender surgery, will have “no fiscal impact,” according to the May 29 Global Commitment Register.
The public comment period is open until July 17, 2019. Comments may be emailed to AHS.MedicaidPolicy@vermont.gov, or mailed to Agency of Human Services Medicaid Policy Unit 280 State Drive, Center Building Waterbury, Vermont 05671-1000. A public hearing will be held July 10, 2019 at 1 pm in Conference Room Cherry C, Waterbury State Office Complex, 280 State Drive, Waterbury.
The proposed rule change was reportedly celebrated by Outright Vermont, an LGBT organization. Executive Director Dana Kaplan was quoted in today’s Burlington Free Press as saying that a “staggering” percentage of transgender youth have considered suicide. He is quoted as saying, “Here [transgender surgery] is an opportunity to say you can live the life that is authentically yours. Why would we get in the way of that?”
The Free Press story does not feature any expert point-of-view questioning transgender surgery or Kaplan’s comments. But other perspectives do exist. Dr. Allan Josephson, former professor at the University of Louisville and chief of its child and adolescent psychiatry/psychology department, stated the following in a 2017 panel discussion at the Heritage Foundation, according to the June 2019 Decision magazine:
“The notion that gender identity should trump chromosomes, hormones, internal reproductive organs, external genitalia and secondary sex characteristics when classifying individuals is counter to medical science,” he said. “Children persistently, insistently and consistently demand many things that are not good for them. A parent’s role is to resist those demands when parental wisdom trumps children’s limited life experience.”
For making these statements, Josephson drew criticism from the campus LGBT center, Decision reported. He was demoted to junior faculty member and eventually his contract was not renewed. Josephson has filed suit for violation of his First and 14th Amendment rights. The Alliance Defending Freedom is providing legal assistance.
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.