Transgender Medicaid: Empty Show or Unknown Cost

Answers took some days to receive and to clarify, but I’ve been meaning to follow up on this Richard Salit article in the Providence Journal:

Rhode Island is now among a handful of states that has expanded its Medicaid benefits to include medical care for transgender people, including mental health treatment, hormone therapy and sexual reassignment surgery.  

The policy change, announced a week ago, is being hailed by lesbian, gay, bisexual and transgender advocacy groups, who say the benefits should now be offered by private insurers as well.

I asked spokespeople for the state how much the change is projected to cost, and the answer, in a word, was nothing.  More specifically:

In its proposed rules for Nondiscrimination in Health Programs and Activities, the US Department of Health and Human Services states that it expects [these expanded benefits to] impact a very small segment of the population, and will have minimal impact on the overall cost of care and on health insurance premiums.

This determination is based on a study in California that found that covering transgender individuals under California’s private and public health insurance plans would have an insignificant and immaterial economic impact on costs (based on evidence of low use and the relatively small transgender population).

We do not have cost estimates specific to Rhode Island’s Medicaid’s program.

Overall, it looks like the goal is more to pressure insurers to make the same change as part of a political effort to define transgender operations as a human right, meaning that a failure to pass along the cost for these rare treatments to everybody else through the cost of regular medical care would be discrimination.

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