Colorado to require some insurance plans to cover gender-affirming care

Beginning in 2023, health insurance plans covering about a quarter of Colorado’s market will have to pay for gender-affirming care, some additional mental health services, and pain management alternatives like acupuncture.

The changes will affect plans sold in the personal and small group markets – so they won’t apply to people who get their insurance from large employers or government programs like Medicare.

Gender-affirming care is an umbrella term for services to transgender or non-binary people, which may include hormonal treatments, permanent facial hair removal, counseling, speech therapy, or surgery. Cisgender people sometimes also seek gender-affirming care, such as breast reconstruction after mastectomy (although they may not think of it in those terms).

The state legislature should act to require insurance plans from large employers to cover gender-affirming care.

Transgender people who have received gender-affirming care have lower rates of depression than those who have been refused care and are less likely to report suicidal thoughts.

Colorado Insurance Commissioner Michael Conway estimated the new benefits would cost around 64 cents per customer each month. Governor Jared Polis told a press conference that they will end up saving money by reducing the risk of serious mental health issues in the future.

“I had to be convinced it would save over 64 cents a month,” he said.

The requirement that plans cover an annual mental health check-up and opioid alternatives came from bills passed in the last legislative session, which also require large-group plans to provide the same coverage. Gender-affirming care requirements originated from an administrative process, with the Division of Insurance consulting with stakeholders before seeking authorization from the Federal Centers for Medicare and Medicaid Services.

Jefferson County Democrat Senator Brittany Pettersen said the requirement to cover non-drug pain treatments, such as acupuncture, would give patients options to avoid the risk of opioid addiction. Some studies have shown that acupuncture relieves pain, although there is an ongoing debate on how much of the improvement is due to a placebo effect.

“For decades we had a system that encouraged overprescribing,” she said. Doctors “often talk about, ‘This (opioid drug) is the only thing covered by insurance.’ This is unacceptable. “

The Centers for Medicare and Medicaid Services had to approve any new requirements for the state’s “benchmark” plan, which dictates what should be covered by individual and small-group market plans. Chiquita Brooks-LaSurek, the agency’s administrator, traveled to Colorado to announce the approval at a press conference with Polis and other state officials on Tuesday.

States tend to watch each other’s health policy changes, so it is possible that others may decide to follow Colorado in increasing benefits, Brooks-LaSure said.

“Today is the first time that a state has sought to add gender care as an essential health benefit,” she said. “I hope this marks a historic start.”

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