Maryland votes to expand Medicaid gender-affirming care

ANNAPOLIS, Md. (AP) — Maryland lawmakers gave final approval Thursday to expanding procedures relating to gender-affirming care that are covered by the state’s Medicaid program.

The 93-39 vote by the House of Delegates sends the measure to Gov. Wes Moore, a Democrat who has said he will sign the bill.

The state’s Medicaid program currently limits gender-affirming care to a handful of procedures, such as mental health services for gender dysphoria, continuous hormone replacement therapy, and gender reassignment surgery.

The Trans Health Equity Act expands coverage to procedures that include hair alteration, voice modification surgery and therapy, alterations to the abdomen, trunk, face and neck and fertility preservation services. Revisions and reversals of prior treatments also would be covered.

Under current law, Medicaid covers gender-affirming treatments for people who are 18 and have the capacity to make informed decisions and consent for treatment. People also have to have a diagnosis of gender dysphoria and undergo at least a year of continuous hormonal therapy when recommended by a mental health professional. A person also must have two referrals from qualified mental health professionals who independently assess the individual.

The bill enabling expansion of coverage would take effect Jan. 1.

Much of the debate by opponents of the legislation has focused on efforts to specifically define in the bill that surgeries would be prohibited for people under 18. But supporters say the measure does not change current Maryland law on that point regarding minors, who are prescribed puberty blockers and hormone treatment instead of surgery.

Health care decisions for transgender youth in the state require parental consent.

“No child is making this decision independently,” said Del. Bonnie Cullison, a Montgomery County Democrat, during debate Thursday.

Only in very rare occasions would surgery be an option for someone under 18, if a parent, patient and medical providers believed someone would be “in danger without that kind of treatment,” Cullison said.

“We would say under no circumstances can we allow an individual who is at risk of self-harm, serious risk for self-harm, to not get the treatment they need,” Cullison said.

Last year, about 100 people received gender-affirming treatment through Medicaid, according to a state analysis. The analysis said the number of Medicaid enrollees seeking gender-affirming treatment under the bill is estimated to increase by about 25 people a year, according to the Maryland Department of Health.

The health department also said that while there appears to be an extremely low prevalence of regret in transgender patients after receiving gender-affirming surgeries, approximately 1% may seek reversal of treatments, according to the state analysis by the Department of Legislative Services.

About 24,000 Maryland residents are transgender, and 6,000 are enrolled in Medicaid, according to the Williams Institute at UCLA.

The legislation in heavily-Democratic Maryland comes at a time when GOP-controlled states around the nation are considering bans or restrictions to access to gender-affirming care.