In October 2021, Colorado became the first state in the country to explicitly include comprehensive gender-affirming care services into its 2023 minimum health coverage benchmark health insurance plan.
The plan incorporates expanded behavioral health coverage for those with gender dysphoria, hormone therapies, and “exhaustive” surgical interventions, according to Cara Cheevers, behavioral health program director at the Colorado Division of Insurance (DOI).
Stay one step ahead. Join our email list for the latest news.Subscribe
Lt. Gov. Dianne Primavera, director of the Office of Saving People Money on Health Care, said:
“Today’s announcement means that gender diverse Coloradans can stop guessing at how and which gender-affirming benefits are included in their coverage.”
Before the Centers for Medicare and Medicaid’s (CMS) approval of this benchmark plan, many insurance companies’ coverage of gender-affirming care varied greatly. This disparity and variation in coverage was unable to be confirmed with data due to the lack of data collection for sexual orientation or gender identity. Cheevers said:
“If you’re not counted, it’s really hard to advocate and fight for the things that you need.”
Colorado has been working to close this gap since 2008, when Senate Bill 08-200 expanded protections from discrimination in public accommodations, including health care, that were specifically based on sexual orientation and gender identity.
Cheevers said it was not until 2017 that all commercial health plans did not have any specific exclusion of coverage for transgender care. Many complaints and testimonies from advocacy groups led to continued work to provide access to care for transgender folks, especially transgender youth.
When the state reopened its benchmark plan in October, they solidified access to medically-necessary treatments to LGBTQA+ communities throughout all parts of the health insurance markets and processes.
This includes expanded behavioral health care coverage, which Cheevers says is often needed when undergoing gender-affirming treatments. The plan also included coverage for hormone therapy—which includes receiving hormones that better align with a person’s gender identity.
The plan also included coverage to more surgical interventions like top surgery—the procedure to remove chest or breast tissue—, facial feminization surgery, or bottom surgery—the procedure to reconstruct genitalia to that of one’s gender identity.
Cheevers said CMS Administrator Chiquita Brooks-Lasure intends for other states to follow in Colorado’s footsteps and hopes this can eventually happen at the federal level. She said many other states have contacted DOI asking how to include gender-affirming care into their next benchmark.
Cheevers said this benchmark expansion will be “lifesaving” and “life-improving.”
“I have a number of friends and colleagues who identify as transgender, and I think, for trans women in particular—who are for the first time starting in 2023 able to get facial feminization surgery—it will have a direct impact on the quality of life.”