Statehouse Headliners: Medicaid considering covering transgender surgery for youth

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.

Guy Page is affiliated with the Vermont Energy Partnership, the Vermont Alliance for Ethical Healthcare, and Physicians, Families & Friends for a Better Vermont.

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, 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.

Image courtesy of Michael Bielawski/TNR

9 thoughts on “Statehouse Headliners: Medicaid considering covering transgender surgery for youth

  1. I strongly concur with others’ posted comments, especially with those of “Beagle,” whoever you are. In my 75 years of life I’ve never seen anything like it. Wholesale death to babies up to birth – or beyond; commercialize pot, abolish local control of our schools, gay marriage, gender reassignment, open borders, sanctuary state, eliminate private gun ownership by incrementalism, restrict “free speech” to only that which passes the left’s PC filters, etc.; all this and so much more while our infrastructure, roads and bridges crumble before our eyes, homelessness and drug addiction explode. And, yes, while we lose population and have to pay folks to come here! Not to sound the alarm any louder, but it may already be too late. The second generation of refugee hippies who came here 50 years ago and took over now run the show. Our kids have already flown the coop. We may be next. So sad… rlw

  2. It is a scientific fact that sex is determined at the moment of conception. After that every cell in the body carries the same genetic code. How can anybody change that?

  3. The only “free” health care given to the gender confused should be MENTAL HEALTH CARE..
    Their obviously not right in the head if they can’t conform to biological science. You got a inny your
    a girl, ya got a outty your a guy.. any other variation is made up, easy peasy…

    The people perpetrating this thousand gender idealism need to be shot or at least held accountable
    for the youth deaths they do cause by suicide.

  4. This is beyond belief, but then this is ultra liberal Vermont. Nothing should shock us any longer.

    When it came to gun legislation, the liberals argued that the age to buy a firearm needed to be raised to 21 as the brain of children/young adults does not reach maturity until around 25 years of age; too young for them to be able to rationalize or understand the consequences of their actions. They applied this same standard for smoking, drinking, marijuana, etc. so it must be valid.

    Now these idiotic hypocrites are applying a different standard to alleviate gender dysphoria. They are okay with children in puberty, or even before, making a case for gender-affirming surgery. Can you imagine how many basket cases we will see in short order? We will need another state hospital to house them all.

    It is the proponents for this catastrophic ideology that are the mentally ill people in our society. This is the crap they are pushing on our children. These are same people that pushed their hatred of Donald Trump on their students. These students, after seeing Trump’s name written in chalk on a sidewalk, needed counseling as they could not deal with the horrific stresses that every conveyance of Trump’s ideas was causing. His ideas seemed to cause everything possible from depression to bed wetting. Any wonder millennial’s can’t deal with job stress, relationships, leaving home, etc.? Their answer is drugs, video games, psychotherapy, suicide, and above all, dependence on the government.

    Every liberal’s answer to our societal structure is “PEOPLE CONTROL”! Do what ever you have to do to make people dependent on the government. Bernie and other Progressive Socialist’s ideas include Medicare for all, free education, paying off school loans, allowing every illegal alien in this country free access, abortions rather than birth control, etc. All these things remove important basic human traits, such as responsibility, self esteem, reputation, dependability, paying your own way, etc. They want no more valedictorians or salutatorians and everyone gets a participation award. No more trophy’s and recognition for individual achievement.

    I could go on, but it is a waste of words as these people don’t care what they are doing to Vermont or to this country. Vermonters are voicing their disdain for what is happening by packing up and moving out of the state.

    To quote a recent statement that I saw, “In society there are MAKERS and there are TAKERS”. Vermont is losing the MAKERS and those left are the TAKERS. They (lawmakers) can’t cover the bills today. What will it look like in a few years when the established money is gone and taxes are so high that the majority of one’s money is absorbed by the free spending socialist liberals and nothing is left to live on.

    Everyone should be frightened out of their wits as to what is coming. The future is very bleak. VOTE THESE IDIOTS OUT OF OFFICE before it is to late!!

  5. Any doctor that alters a child’s sex should be sued for malpractice and lose their license. The WORST kind of child abuse.

  6. Dana Kaplan-director of outright VT says gender identity develops as young as 3 yrs. old. Where does that data come from? There is none.
    These adults are putting these ideas in the heads of these kids at a very young age. It’s no wonder we have a society of kids growing up confused and feeling unaccepted.
    It’s also no wonder there is a rapidly increased amount of teen suicides. They’re so confused, they don’t know what’s up or down.
    Get these issues out of the education system. Furthermore, I don’t want any more of my tax dollars paying for transgender surgeries. They also stated in the BFP that 50% of the Vermont population under 18 is on medicaid..
    This just verifies what a sad State this is becoming.

    • The only lesson to be learned here is – get the hell out of Vermont as soon as you can. The State is headed for bankruptcy, just like Sacramento and Detroit.

      I’d love to stick around and watch the protesting State employees and Teachers scream while their pensions and healthcare get cancelled, but I’ll have to play my tiny violin from somewhere more solvent.

  7. Give me a break, if these ” fruitcake ” kids, want to be mutilated that should be on there
    dime, not my tax dollars.

    What should be covered is a trip to the leather couch or shock therapy !!

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