Pennsylvania Makes 17 States + D.C. Banning Trans Health Exclusions, Hawaii Likely Next | National Center for Transgender Equality


Friday, May 6, 2016

Pennsylvania Makes 17 States + D.C. Banning Trans Health Exclusions, Hawaii Likely Next

With guidance issued on April 30 by Pennsylvania’s Insurance Commissioner, the Keystone State makes 17 states, plus the District of Columbia, that have taken action to ban discriminatory transgender exclusions in health insurance plans. Pennsylvania joins California, Colorado, Connecticut, Delaware, Illinois, Massachusetts, Michigan, Minnesota, Montana, Nevada, New York, Oregon, Rhode Island, Vermont, Washington State, and D.C., as well as the federal Medicare program, in banning these exclusions, which are contrary to medical science and federal and state laws. The U.S. Department of Health and Human Services is expected to soon publish final rules banning exclusions in most insurance plans nationwide.

Pennsylvania’s guidance is based on the state’s longstanding law against unfair insurance practices, as well as federal law and regulations prohibiting gender-based discrimination. It states that in order to comply with these laws, insurance companies have to get rid of categorical exclusions that say that transition-related care is not covered. The guidance also says that insurance companies also can’t refuse to cover a service like surgeries or hormone treatments simply because it’s being used to help someone transition. 

Meanwhile, legislation was sent last week to Hawaii Governor David Ige, who is expected to sign it, which will add the Aloha State as the 17th to prohibit transgender exclusions in healthcare plans. The Hawaii legislation contains similar requirements to the Pennsylvania guidance, and provides that medically necessary standards for transition-related care must be similar to standards for other individuals and conditions.

Other states have issued bulletins or regulations prohibiting transgender exclusions based on existing state and federal nondiscrimination and fair business practice laws, like Pennsylvania did. Hawaii is unusual in enacting more specific legislation, and the state’s own insurance commissioner could likely take similar action based on existing Hawaii and federal law.  Regardless of the process used, the result is an important step toward equal access to necessary health care.

NCTE applauds Pennsylvania and Hawaii for taking these necessary steps to ensure that medically necessary healthcare is accessible to transgender people. We urge people in these states and around the country to consult our Healthcare Know Your Rights resource, and to contact trans-friendly legal organizations if they are denied the transition-related care recommended by their provider.

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