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Shawnte Anderson lived for the weekend. Growing up black and transgender in a small West Virginia city in the 1990s, she spent much of her time alone, hid her knowledge from her mother, and dealt with ridicule from her classmates. But on Friday and Saturday nights, she was able to lock herself in her room, wear Whitney Houston and Aretha Franklin, and try on some of the women’s clothing she had hidden away. I put on makeup and looked at myself in the mirror.Make yourself feel pretty,’ says Anderson, now 46. Yet the night always had to end. “As I wiped it away, I just had quiet tears streaming down my face,” she recalls.
When she came out to doctors as a teenager, Anderson says she was told there was nothing she could do for her.As an adult without health insurance, she wants her body to change so badly. Doctors eventually agreed to treat her for gender dysphoria until she turned 40 and was incarcerated in federal prison. did not do it.
Anderson says it was “liberating” to finally get the prescription hormones she needed for years. Her skin softened. Her breasts have grown. A cellmate, also transgender, noted the gradual change in her figure.
But when Anderson was released from a half-baked home in 2020, she stumbled upon what she calls “a brick wall”: Medicaid. Under West Virginia’s policy, Medicaid would cover her hormones, but not the surgeries needed to continue her medical sex reassignment. ‘ says Anderson. Already struggling to cover her bills, she had two minimum wage jobs with zero credit after jail, her transition stopped and her gender dysphoria worsened began to “We got to the point where we were hopeless,” she says. “Because I’m back to square one”
In late 2021, Anderson agreed to participate in a lawsuit challenging West Virginia’s Medicaid exemption from gender confirmation surgery. The lawsuit, filed by LGBTQ civil rights group Lambda Legal and local partners, sees West Virginia deny compensation for surgical procedures used to treat gender dysphoria, and to treat them for other diagnoses. It claimed that it violated federal antidiscrimination laws by authorizing
Last August they won. A federal judge reversed West’s Medicaid exclusion in Virginia. “The same or similar surgical treatments are available…if the diagnosis requiring treatment is not gender dysphoria,” District Court Judge Robert Chambers said in his ruling, citing mastectomy as an example. “Where treatment is excluded because of a diagnosis based on gender identity, such exclusion is unwillingly discriminatory on the basis of gender and transgender status.”
Victory in West Virginia follows landmark 2020 Supreme Court ruling that federal civil rights law prohibiting sex discrimination in employment applies to transgender and gay workers But big. In 2021, Alaska agreed to remove an exception to settle a lawsuit filed by Swan Being, a woman who was denied compensation for costs related to hormone treatments. and agreed to withdraw the exemption for gender confirmation surgery. Also, a lawsuit challenging Florida’s Medicaid exclusion will go to trial in May. Carl Charles, an attorney at Lambda Legal who has worked on other Medicaid cases, said last fall that trans-Medicaid recipients and their I filed a lawsuit in Florida on behalf of my family. Puberty blockers, hormones, surgery.
The momentum to ensure Medicaid coverage for transgender health care is a silver lining at a time when transgender rights are under sustained attack from Republican state legislators. Targeted treatments, such as pubertal blockers for adolescent children, heterosexual hormones for teens or adults, and near-exclusive surgery for adults, are supported by major medical associations and are widely regarded as life-saving. increase. But according to the ACLU, as of Jan. 30, 21 states are considering 77 bills restricting LGBTQ health care. Utah Gov. Spencer Cox on Saturday announced a bill to ban gender reassignment surgery for those under 18 and put a “moratorium” on puberty blockers and hormone therapy for newly diagnosed minors with gender identity disorder. signed. Additionally, her two states, Alabama and Arkansas, already ban gender-affirming treatments for young people, but both bans are pending court challenges. (Arizona and Tennessee also have some bans on gender-affirming care for transgender minors, but transgender rights law experts say these laws are practical. little effect.)
Despite these battles, gender-affirming care for the tens of thousands of transgender adults like Anderson who have health insurance through Medicaid and an unknown number of children. is already effectively banned. Nine states explicitly exempt the coverage of gender-affirming medical care, such as surgery, hormones and treatments, according to an analysis of state Medicaid policies by the Movement Advancement Project. We maintain a Medicaid policy that As a result, according to Williams Institute population estimates, full gender-affirming care is out of reach for her more than 50,000 transgender adults with low income or with disabilities.
Half of Medicaid recipients live in states that have chosen not to expand Medicaid eligibility, such as Tennessee and Texas. “It’s basically impossible for these people to get gender-affirming medicine out of their own pocket,” says Charles. “They are really working with incredibly limited resources.”
Medicaid coverage is particularly important to making health care accessible to trans people as a whole. A 2015 survey on the experience of transgender people found that 29% of respondents were living at or near the poverty line, more than double the U.S. population, and in 2014, eight had One earned less than her $10,000. It is the result of systemic discrimination, harassment, and violence that often begins in the home, continues throughout education, and continues after transgender people enter the workforce. Many “have a hard time holding down jobs because cisgender people don’t allow it,” explains Charles. Prevent them from revealing their gender or fire them as soon as they come out.According to a Human Rights Campaign poll, as of the summer of 2021, those who were able to remain in the traditional workforce will: On average, they earned 30-40% less than the US median weekly wage of $1,001.
Attorney Avatarra Smith-Carrington of Lambda Law Firm said, “Where the law excludes us, we also have to think about transgender Medicaid participants, who are self-sufficient in this important care. They often don’t have the resources or means to access it.” She works with Charles to challenge the state’s Medicaid exclusion for transgender health care. “Because it can mean no money to pay rent, no money to buy food, no money to buy all the other things people need to survive and thrive day by day. .”
Yet, in places like Arizona, Medicaid exceptions that have blocked coverage for gender confirmation surgery since at least 2004 have been a reality for years. like florida, Brand new. At least two of her states, Oklahoma and Virginia, are now considering proposals similar to Florida as part of a larger bill to punish doctors for providing gender-affirming medical care to people under the age of 21. increase. Gender-affirming care is covered and she has 50,000 adults in precarious conditions. “I think there is cause for concern, especially when you’re looking at states that don’t support clear policies,” says Charles. “Conservative Republican state senators are thinking, ‘Hmm, we need to look into a Medicaid program.'”
According to Charles, a legal victory over Medicaid exclusion would help put pressure on private insurers to decide whether to cover transgender health care. It could portend pending court challenges to the care restrictions. Utah is expected to soon face lawsuits over the new ban.
Meanwhile, the West Virginia government is appealing a ruling that removed Medicaid’s exemption from gender-confirming surgery. But for now, the lower court’s ruling stands. The day we spoke, Anderson was looking forward to her appointment to discuss her potential procedure: “I’m really excited,” she says. “It’s like another chapter in this book of mine.”
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