The Needs and Practical Implication of Transgender Healthcare Inclusion


by Emilia Dunham

Reporting from the National Transgender Health Summit in San Francisco

In the afternoon I attended a session led by Andre Wilson and Jamison Green who discussed transgender insurance inclusion.

First of, what does Trans-Inclusive Policies mean?

Insurance policies include:

  • Mental Health care
  • Hormone Replacement Therapy
  • Breast/chest reduction
  • Genital surgeries
  • Hysterectomy

Second, what needs to happen?

  • Advocating: As the metaphor goes, the squeaky wheel gets the wheel, which is the case of trans health inclusion. Here is where grassroots advocacy makes a difference as often it’s the behind-the-scenes work that accomplishes this. Here is how YOU can help, as even as an ally you may have more clout to communicate this need to your organizations, communities and state plans.
  • Community/Organizational Pressure of corporations and state plans: For instance, the Human Rights Campaign (HRC) has something called the Corporate Equality Index in which Fortune 1000 and other major companies are scored on LGBT inclusive policies and environment. Until recently, to get a score 100% in LGBT inclusion, companies had to have at least 1 trans-inclusive health policy coverage of HRT, counseling, short-term disabilities, surgical procedures and/or follow-up procedures/labs. In a game-changing move, with the consultation of Green and Wilson, in 2012, employers will need to cover ALL of these to score 100% and these factors will be weighted twice as strongly. Right now only 85 of these companies have this complete suite of trans inclusion, but this number could spike within the next few years, so the three million Americans who receive coverage from these companies could increase to even more.
  • The need of visibility through medical consensus: For instance, this is the Healthy People 2020 Report, the Institute of Medicine LGBT Health report, AMA, etc. This is how these recommendations and reports can be used for practical implications that change the very lives of trans people in our community.

As to be expected, there are several challenges that have come up

  • Some insurance providers will sometimes ask for more years living full-time in desired gender and/or more letters, even exceeding WPATH standards.
  • Sales/Vendors, call center staff all may say that these plans don’t exist
  • Reimbursement issues: few in-network providers, so people are getting screwed on reimbursements
  • Coding problems

However, despite challenges, there is incredible momentum happening at the grassroots level that will alleviate health disparities for this segment of our community that experiences the very worst of health disparities overall. It’s something that is not terribly expensive (can cost just a few cents per employee); it’s something we ALL can advocate for and it will, again, have a tremendous effect. And there is something very real that can be done!

Published by Emilia Dunham, MPP, MBA

Emilia Dunham is currently a Project Manager at MassHealth/Department of Public Health, and formerly the Project Manager of the Life Skills project at The Fenway Institute, an HIV intervention study for young transgender women. Emilia worked at Fenway for 7 years, first as a Quality Control and Regulatory Assistant mainly involved with biomedical HIV prevention trials, before serving as the Program Associate for The Network for LGBT Health Equity, a network instrumental in many national LGBT health policy improvements. She is also involved with the Massachusetts Transgender Political Coalition, serving as a Steering Committee member and the Policy Committee Co-Chair, an organization largely responsible for the recent passage of the Trans Rights Bill. Additionally she serves as a member of the Massachusetts Commission on Gay, Lesbian, Bisexual and Transgender Youth, Co-Chair of the Recommendations Committee. Emilia received a Bachelor’s degree from Northeastern University. There she served as President of the LGBTQ student group where she planned programs such as Pride Week, Transgender Day of Remembrance, and AIDS Week. In addition, she advocated for LGBTQ inclusive policies and programming on campus such as a Gender Neutral Housing program, an LGBTQ Center and the expansion of Women’s Studies to Women, Gender and Sexuality Studies. Emilia recently earned a Master of Public Policy and Master of Business Administration in health policy and management from the Brandeis Heller School School for Social Policy and Management.

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