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Supporting Coverage of Gender Transition-Related Healthcare in NH



On September 13, 2017, GLAD Executive Director Janson Wu submitted testimony in New Hampshire at a hearing on Medicaid coverage of gender transition-related healthcare supporting the NH Department of Health and Human Services amendment to remove the exclusions for gender transition treatment as non-covered services.

The current provision, “Physician Services-Non-covered Services,” refers to treatment that the consensus of medical providers and medical associations consider medically necessary for treatment of gender dysphoria as non-covered services.

Such exclusions for gender transition treatment are not in accordance with medical authorities and, in fact, violate both state and federal law. We and the ACLU-NH urge the New Hampshire Department of Health and Human Services to adopt the proposed amendment to strike the current provision, which provides that “Sex change operations shall be non-covered.”

Scientific and medical evidence does not support non-coverage of sex reassignment procedures. Gender transition-related care, including provision of sex-reassignment surgery (or so-called “sex change operations”) and other related surgeries and treatments such as hormone therapy, is recognized as medically necessary for the treatment of gender dysphoria.

Gender dysphoria is a real and serious medical condition experienced by many transgender people. The condition is marked by a profound and disorienting misalignment of a person’s gender identity (one’s internalized sense of who that person is as male or female — sometimes referred to as “brain sex”) and his or her assigned birth sex.

The medical professional organizations focused on treatment of gender dysphoria have identified an established course of care and treatment for the condition that includes, in appropriate cases, hormone therapy and surgeries relating to sex-reassignment. Major medical organizations including the American Psychiatric Association, the American Medical Association, and the World Health Organization have recognized the treatment to be medically necessary.

Moreover, federal and state law prohibits exclusions for gender transition treatment. The current exclusion in the provision conflicts with state law relating to nondiscrimination and with the Affordable Care Act and must be removed to ensure that New Hampshire’s Medicaid regulations are in compliance with current state constitutional guarantees and state and federal law.

Read more of our testimony supporting the amendment to remove this exclusion.