Colorado sees surge in gender-affirming medical treatment after insurance policy change

Colorado has seen an explosion in the number of people receiving gender-affirming medical treatment after the state introduced new regulations expanding health benefits for LGBTQ people provided under private and public insurance plans.

That’s according to a September data analysis from the Center for Improving Value in Health Care, the non-profit group that administers the state’s all-payer claims database, a record of claims filed by private and public insurers. Between 2016 and 2021, the analysis found, the rate of individuals receiving gender-affirming care rose over 300%. 

The time period encompasses two critical changes in Colorado health insurance policy: in 2016, the state Department of Health Care Policy and Financing’s Medical Services Board passed a statute for a comprehensive Medicaid transition-related care benefit. And in 2021, the state became the first in the nation to receive federal Centers Centers for Medicare & Medicaid Services approval to include gender-affirming care as an essential health benefit in individual and small group health insurance plans. 

The latter change doesn’t go into effect until 2023, but commercial providers have likely already started to adjust their policies to reflect the change, said Cari Frank, a CIVHC spokesperson. 

LGBTQ advocates and state insurance industry regulators say those changes put Colorado at the forefront of a national movement to address health care disparities faced by the LGBTQ population, contrary to a national effort to politicize health care services for people who identify as transgender. 

“It’s fantastic,” Frank said “These are services that these people have needed for a very long time. Before they would have had to find providers who would accept them, and they would have to negotiate paying for it out of pocket. Now they are actually getting it covered.”

Frank said she hopes that other states interpret the data as proof that policies like Colorados’ work. But she acknowledged that it could also become a talking point for opponents of more comprehensive plans. 

“It does make me nervous because of all of the politics around this,” she said. “In conservative states, they could potentially use this data in a negative way, like, ‘We shouldn’t be covering this because it’s turning kids transgender.’ That’s simply not true.” 

Trade groups representing health care professionals, including the American Medical Association and the American Academy of Pediatrics, have cited the medical benefits of gender transition-related care. The American Medical Association in 2021 urged governors to oppose state legislation that would prohibit medically necessary gender transition-related care for minor patients, calling such efforts “a dangerous intrusion into the practice of medicine.” 

But Republican politicians have seized on gender-identity as a wedge issue in the November elections.  Several legislatures in GOP-controlled states have moved to limit the type of care available to transgender people, especially minors. 

An Oklahoma bill that would would prevent University of Oklahoma medical facilities from providing transition services to transgender children passed both the state House and Senate during a special legislative session last week. 

Tennessee House Republicans sent a letter last week to Vanderbilt Hospital’s Pediatric Transgender Clinic — the only one of its kind in the state — urging it to stop providing gender-affirming surgeries in response to a viral Twitter thread from right-wing pundit Matt Walsh. Vanderbilt University Medical Center has said in a statement that the social media posts “misrepresent facts about the care the Medical Center provides to transgender patients.”

In California last week, Gov. Gavin Newsom (D) signed a measure meant to block out-of-state efforts to penalize families that travel to the state to seek medical treatment for transgender children or teens.

And on Monday, the American Academy of Pediatrics, the American Medical Association and Children’s Hospital Association sent a letter to Attorney General Merrick Garland requesting a Department of Justice investigation into a wave of violent threats targeting medical providers who care for transgender children.

In Colorado, the number of gender-affirming care services for Medicaid youth and young adults has increased nearly 11-fold, from over 1,800 in 2016 to over 11,500 in 2021, and five times the number of unique individuals are receiving services, according the the CIVHC report. 

Plans sold on the individual and small group market, which will have to comply with the 2021 requirement, account for about a quarter of the state’s insured population. Additional care that would be covered included eye and lid modifications, face tightening, facial bone remodeling, breast and chest reduction and construction and laser hair removal.The CIVHC analysis shows nearly nine times the number of services and five times the number of individuals receiving gender-affirming care since 2016. 

Opponents of the new benefits included the Colorado Association of Health Plans, which represents the health insurance industry. That group said in 2021 it believes the new benefits, along with bills passed in the previous legislative  session, would increase premium costs by 1%-1.5% each year. 

Republican state Rep. Patrick Neville, who serves on the Health and Insurance Committee said in 2021 that the new covered benefits were “bad for the American worker” and amounted to “insurance mandates.” He did not return a request for comment this week.  

But state insurance officials said the change would amount to a minimal increase in insurance premiums. “It’s pennies a month,” said Cara Cheevers, Director of Behavioral Health Programs for the state Department of Regulatory Agencies. “This is medically necessary healthcare, period. It saves lives. And it will reduce costs, pretty much immediately, by getting somebody that preventive, medically necessary health care that they need.” 

Federal officials have urged other states to follow Colorado’s lead. The CMS issued a 2021 statement calling the state’s revision to its benchmark plans a “landmark step” “aligned with the Biden-Harris Administration’s efforts to address health care disparities by removing longstanding barriers and expanding access to care for transgender persons.”

A CMS spokesperson said last week that the agency has not received a request to add similar benefits to any other state benchmark plan.