Woman standing on a balcony
Rikki Bates

Gender transition-related medical care is necessary medical care for many transgender people, but getting that care paid for can be a huge barrier.  Private and public insurers have traditionally simply excluded gender transition-related procedures from their coverage based on the unfounded assumption that treatment is experimental, elective, or cosmetic. Transgender people are disproportionately represented in prison, and they, too, have limited and, most often, no access to care.

GLAD is working across a range of contexts to guarantee access to medically necessary care for all transgender people, whatever their situation in life.  Each victory lays the groundwork for the next, because each time we establish the reality and legitimacy of transgender people’s medical needs, we make it easier for others to make the case.

  • GLAD worked with the Massachusetts Department of Corrections (DOC) to encourage DOC’s creation of an ombudsperson position to individually evaluate and develop medical treatment plans for transgender people in the prison system.  We are regularly in contact with several inmates who are challenging denials of health care.  We expect to regularly meet with the ombudsperson to continue to advocate for those inmates who are in touch with us.
  • GLAD is in the initial stages of bringing a case on behalf of a Massachusetts state employee denied surgical coverage by the Group Insurance Commission plan.
  • GLAD represents Rikki Bates (pictured above) in a challenge to MassHealth’s denial of coverage for gender transition-related surgery; GLAD had previously helped her successfully challenge MassHealth’s denial of her coverage for hormone therapy.
  • GLAD worked with the Massachusetts Department of Youth Services and other advocates to revise state policy to include gender transition-related care for youth in juvenile justice settings.  GLAD is working in Rhode Island to ensure this same result across both child welfare and juvenile justice settings.
  • In Connecticut, GLAD advocated on behalf of a transgender state employee who was initially denied coverage for his gender transition-related surgery because of a categorical exclusion in the state insurance plan.  GLAD worked with his union representative to secure a resolution from the union eliminating the insurance exclusion for all state employees.
  • By working with state insurance commissions, GLAD has expanded access to private insurance coverage in Vermont and Connecticut, where state insurance commissions issued bulletins to insurers advising that they could not exclude coverage for gender transition-related care.  In Vermont, this bulletin was followed by a revision of the state-sponsored insurance plans to remove exclusions in those plans.
  • GLAD is working with insurance commissions throughout the rest of the New England states to secure bulletins clarifying the impermissibility of exclusionary plans.
  • GLAD represents Michelle Kosilek in the appeal by the Massachusetts Department of Corrections of the federal district court’s order that she receive gender-transition surgery.
  • GLAD worked with the National Center for Lesbian Rights and the ACLU to successfully challenge Medicare’s exclusion of gender transition-related surgeries. A final ruling issued May 30 by the U.S. Department of Health and Human Services Department Appeals Board removes the threshold barrier to coverage for care for transgender people under Medicare.
  • GLAD represented Vanessa Adams, an incarcerated transgender woman, in a challenge to the federal Bureau of Prison’s (BOP) exclusion of medical treatment for persons who come into BOP without a treatment plan.  That case lead to a settlement in which BOP agreed to provide our client with treatment and also revised federal policy to eliminate its “freeze frame” policy.
  • GLAD successfully challenged the IRS’s denial of a taxpayer’s medical deduction for gender transition related care in O’Donnabhain v. IRS.  Now all transgender taxpayers can deduct their medically necessary transition-related expenses.
  • In Beger v. DMA, GLAD secured a Superior Court order ruling that the Division of Medical Assistance had to cover breast reconstruction surgery for a transgender woman, needed as the result of defective breast implants.