Maryland implements Medicaid expansions for gender-affirming care

(The Center Square) — Effective Jan. 1, through its Trans Health Equity Act, Maryland Medicaid coverage has expanded gender-affirming services and procedures.

It has expanded from mental health services, hormone replacement therapy and gender reassignment surgery to include body contouring, vocal surgery and therapy, hair removal, puberty blockers, fertility preservation and various other cosmetic surgeries. It also covers the revision or reversal of prior gender-affirming procedures.

“Maryland Medicaid covers medically needed care that upholds the safety, dignity and respect of transgender and gender expansive people. Gender affirming care is for those who need medical care to make their body match their lived gender,” reads the Maryland Department of Health’s webpage on gender-affirming care.

Under the new law, cosmetic surgeries are included among services regarded as medically necessary, as long as they are “consistent with current clinical standards of care prescribed by a licensed health care provider.”

Maryland Medicaid still requires that patients be 18 or older, have a diagnosis of gender dysphoria, undergo at least 12 months of continuous hormone therapy per the recommendation of a mental health professional, and give their full and informed consent for any treatment they’re pursuing. If seeking surgery, patients must receive two referrals from a mental health professional to obtain coverage.

Though just under 100 Medicaid-enrolled Marylanders sought gender-affirming care in 2022, according to a Williams Institute study, the costs of expanded coverage may be substantial. The effects on small businesses are “meaningful.” However, significant federal matching funds are also available for approved care.

“Assuming the federal Centers for Medicare and Medicaid Services approve coverage for fertility preservation services for this population, such services would be subject to a 90% federal matching rate; all other services would be subject to a federal matching rate of 64.5% in fiscal 2024 and 63.9% in fiscal 2025 and thereafter,” according to the Fiscal and Policy Note attached to the bill.

The bill was sponsored by Del. Anne Kaiser and cosponsored by 59 other House Democrats. It passed 93-37 (the current Democratic majority in the Maryland House of Delegates is 102-39).

It was celebrated by many of the state’s Democratic lawmakers and LGBTQ advocates, such as the Human Rights Campaign. The Mental Health Association of Maryland called the law a “huge win” and a “critical first step in creating more equitable Medicare coverage.”