It’s no secret that the cost of gender transition is high, running to tens of thousands of dollars for a male-to-female sex change operation, to say nothing of the ongoing costs of counselling and hormone therapies. California, long the leading edge of cultural evolution, has covered sex reassignment surgery under its state Medicaid program, Medi-Cal, since the California Supreme Court issued a ruling in 2001 that declared the procedures “medically necessary treatment” for those who suffer from gender dysphoria. While it certainly represented a welcome, socially enlightened view towards the transgendered, the rub was that the reimbursement rates afforded by Medi-Cal were not high enough, and many doctors specializing in sex reassignment surgeries and other transition-related health care procedures were unwilling to accept Medi-Cal rates, making it near-impossible for transgendered Medi-Cal beneficiaries to find treatment.
In recent years, Medi-Cal has shifted patients to private managed care plans, which have opened up new options to those looking for sexual reassignment, and with the expansion of Medi-Cal to those earning 138% of the federal poverty line as well as the rollout of subsidized health insurance to those above, has resulted in a wave of transgendered patients who can now make the transition they’ve long dreamed of. To make matters easier for patients, the San Francisco Department of public health has launched the Transgender Health Project for patients and healthcare providers, which provides a managed and easier to navigate path to sexual reassignment surgeries for low-income patients, covering everything from mental healthcare, primary care and sex reassignment surgery as well as post-op aftercare.
While there are some provisions in the Affordable Care Act that prohibit discrimination against those who are transgendered, insurance companies can no longer label one’s transgender identity as a “pre-existing condition” to deny a person coverage. That hasn’t prevented many insurers outside of California from asserting that sex change operations are “cosmetic procedures,” though increasing understanding of the condition has led to many of America’s top universities to include gender reassignment/confirmation therapies and surgeries in their student health insurance plans.
According to the Human Rights Campaign, the nation’s largest GLBT rights organization, more than one quarter of Fortune 500 companies currently have health plans that cover sex changes, and a larger number cover hormone therapy.
While the battle for full equality and acceptance by the cisgender community will be ongoing for the foreseeable future, progress slow as it is, is nonetheless occurring, and it is just a matter of time before it is achieved.