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Biden signs off on Colorado’s expansion of transgender-related health coverage

Pilot initiative would broaden benefits in latest departure from Trump-era policies

The Biden administration will allow Colorado to require some health plans to cover services sought by transgender patients. (AP Photo/Carolyn Kaster)
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Under a groundbreaking decision by state and federal officials, many private health plans sold in Colorado will soon be required to cover hormone therapy, genital reconstructive services and other procedures sought by transgender patients.

The change, which would take effect on Jan. 1, 2023, would mark the first time the federal government has approved a requirement for transition-related coverage in individual and small-group health plans. More than a dozen states, including Colorado, already cover such services in their Medicaid plans.

Biden officials cited discrimination facing transgender patients and predicted the Colorado decision would serve as a road map for other states seeking to broaden such coverage. They also said the approval helps fulfill the president’s campaign pledge to expand access to coverage for LGBTQ Americans, including requiring insurers to cover care related to transitions.

“Colorado’s taking a very important step,” Health and Human Services Secretary Xavier Becerra said in an interview. “Transgender [people] face discrimination on a constant basis. And it is, to some degree, intensified by the inability for transgender Americans to get the health-care services they need.”

Tuesday’s announcement is the latest in a series of Biden administration decisions to codify policies sought by LGBTQ Americans, including a May 2021 announcement to broaden anti-discrimination protections for transgender patients. The Trump administration narrowed access to those protections.

Colorado Gov. Jared Polis (D), Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure and other officials announced the policy in Denver on Tuesday. The new coverage for transition-related procedures, which was authorized under a Trump-era policy that allows states to request modifications to their health insurance markets governed by the Affordable Care Act, would require Colorado health plans to provide “gender-affirming care” among the essential benefits guaranteed to their customers.

“We hope this marks a historic beginning, and that other states look to Colorado as a model,” Brooks-LaSure said. “We invite other states to follow suit.”

The decision was cheered by patient advocates, but panned by some conservatives, who challenged the evidence supporting it, and argued the administration’s move is inappropriate.

“This is a liberal administration and governor colluding to mandate coverage for a lifetime of cross-sex hormones and removal of healthy organs, including for minors,” said Roger Severino, a former Trump appointee who served as the health department’s civil rights chief. “Their end game is clear, to push these dangerous experimental treatments on kids and unwilling families as a national insurance mandate.”

Some transgender patients have detailed the challenges they face obtaining costly services like hormone therapy, saying that interruptions or delays in care can lead to long-lasting setbacks in their transitions. A November 2020 study by Out2Enroll, an organization that helps the LGBTQ community obtain health insurance, found that most plans sold through the government’s health insurance website,, failed to specify whether they covered care for transgender patients. In 7 percent of cases, health plans explicitly excluded procedures for transgender patients, Out2Enroll found.

Many private health plans in Colorado already cover transition-related procedures like hormone therapy, according to One Colorado, an LGBTQ advocacy organization. But officials in states led by Republican governors, like Arkansas and Texas, have moved to limit access to care for people seeking to transition.

Katie Keith, a lawyer and co-founder of Out2Enroll, said that transgender patients in every state should be able to access the care they need under a provision in the Affordable Care Act barring discrimination. Nonetheless, they often face denials or rejections because health plan policies are not always explicit about what they do or do not cover.

“There’s been significant progress, but we’ve seen exclusions by some health plans — it got worse under the Trump administration — and that’s why it’s important to see states like Colorado stepping up to fill those gaps,” Keith said.

[Biden administration revives anti-bias protections in health care for transgender people]

Under Tuesday’s announcement, treatments like facial bone remodeling for facial feminization, breast construction and reductions, and laser hair removal will also be considered as essential health benefits in Colorado. Brooks-LaSure and other officials called the procedures “lifesaving,” citing evidence that helping transgender patients to transition can reduce risk of suicide and boost other health outcomes.

“I know, from personal experience, how important it is to feel safe, comfortable and heard by the providers who help us manage the most intimate and sometimes most painful health-care needs that we have,” said Colorado Lt. Gov. Dianne Primavera (D). “As a state, we want to support patients and providers as we create a more inclusive and affirming health care system.”

The American Medical Association, the American Psychiatric Association and other medical groups have called for health-care organizations to institute protections and expand care for transgender patients.

“Gender-affirming care is medically-necessary, evidence-based care that improves the physical and mental health of transgender and gender-diverse people,” Michael Suk, an AMA board member, said in a June 2021 statement.

Separately, the federal government also authorized Colorado’s requests to include mental wellness exams and acupuncture for chronic pain as essential benefits too.