With the release of a letter that will save lives across the state, California has made it clear that insurance plans are no longer allowed to arbitrarily deny medically necessary care to any patient simply because they are transgender.
Earlier this week, California’s Department of Managed Health Care (DMHC) clarified the obligations of California’s health plans under the Insurance Gender Nondiscrimination Act. In a directive to health plans, DMHC confirmed that all people have the right to access medically necessary care regardless of their gender identity or gender expression. Any treatment that a health plan allows generally also has to be allowed for transgender individuals. Health plans are no longer allowed to exclude coverage of “transsexual surgery” or “transgender or gender dysphoria conditions.” Additionally, if transgender people are denied care they have the right to appeal to DMHC’s Independent Medical Review process.
Combined with a similar ruling from the CA Department of Insurance in 2012, this means that no California insurance plan can deny people care simply because they are transgender. With up to 15% of transgender patients denied gender-specific care such as pap smears or prostate exams, this is a major victory that will improve the lives and health of transgender people and communities throughout California. These directives constitute a major step toward equal access to health care.
If you have questions about this announcement, or other questions about health coverage in and HMO or PPO regulated by DMHC, you can contact their Help Center at 888-466-2219 or www.HealthHelp.ca.gov.
You can reach the California Department of Insurance at 800-927-HELP(4357) or www.insurance.ca.gov/contact-us/
Transgender people who have legal questions or experience discrimination should contact the