Maryland Pushes Back, Passes Trans Coverage For All Gender Procedures Through Medicaid

With many states passing anti-trans bills, some states have pushed back and protected their trans citizens. Maryland is one of those states with the passage of the Trans Health Equity Act.

Final vote on the Trans Health Equity Act

Anti-trans legislation is sweeping the nation, with 10 states now banning gender-affirming care for transgender youth. Meanwhile, some states are considering bills targeting various groups of transgender adults. For example, Indiana lawmakers will debate a bill that would forcibly detransition incarcerated trans adults, while Texas has proposed legislation affecting gender-affirming care up to age 26. In contrast, other states are pushing back against this trend. On March 20, Maryland passed legislation requiring Medicaid to cover modern gender-affirming care procedures for economically disadvantaged trans residents. As the fourth state to mandate coverage of these modern standards of care, Maryland has positioned itself among the most protective states for transgender people, according to my transgender legislative risk map.

The bill, SB460 along with its companion bill, HB283, mandates that procedures currently recognized as beneficial in the World Professional Association of Transgender Health’s Standards of Care 8 should be covered by Medicaid. These include things such as hair removal, facial feminization surgery, chest surgery, and voice therapy. All of these procedures have been deemed helpful and possibly life-saving for transgender individuals due to the quality of life improvements that result from them. See for instance, the WPATH SOC8’s statement on hair removal:

Gender-affirming interventions may also include hair removal/transplant procedures, voice therapy/surgery, counseling, and other medical procedures required to effectively affirm an individual’s gender identity and reduce gender incongruence and dysphoria.

For some transgender people, these procedures help them pass as their gender easier which will allow them to avoid dangerous and possibly violent conflicts as anti-trans violence and intimidation rise. For others, it will help alleviate dysphoria that can dramatically improve mental health. Regardless of the reason for obtaining the surgery, advocates have called for their inclusion in gender affirming care insurance coverage for years.

The main argument behind the passage of this bill is that insurers up until recently have only covered procedures recognized by decades old standards of care. In old standards of care, no such statement was made over the ability of these procedures to alleviate gender dysphoria. Insurers, even in progressive states, based their insurance coverage off of these old standards of care. Despite evidence emerging that, for instance, gender affirming facial surgery could significantly improve gender dysphoria, insurers refused to update their standards and categorically denied these procedures as cosmetic.

Maryland’s Trans Health Equity act sought to end these denials and modernize the standards of care. For a full list of procedures that Medicaid will now cover for transgender Marylanders, see from the bill:

List of gender affirming treatments now covered by Medicaid in Maryland

Maryland, through the passage of this legislation, becomes one of four states that now cover modern standards of care for transgender residents. Washington passed a bill in 2021 that mandated coverage for both public and private insurers. Colorado soon followed suit. Last year, after much debate, Hawaii also managed to pass this legislation. Although Maryland’s bill does not go as far as other bills in that it only applies to Medicaid, it will protect the most economically disadvantaged trans residents and ensure that they get the coverage they need to obtain any procedures recommended by their medical teams.

I asked Margo Quinlan, one of the main activists responsible this legislation, what this means for transgender Marylanders. She replied:

This campaign shows what happens when trans people are leading the conversations about our care, our safety, and our dignity. What we're advancing here in Maryland will provide some of the most comprehensive life saving care available for those of us in community who are already the most vulnerable. This will absolutely change lives and save lives.

It is important to remember that as states continue to push harmful legislation towards the transgender community, some states are moving against this trend. States like Minnesota are enacting policies to protect transgender refugees who reach the borders. New Mexico passed a bill that protects the right to gender affirming care. Nevada passed a popular referendum that mirrors the equal rights act via a ballot initiative. Michigan has recently passed similar legislation. The United States is not trending towards harming transgender people, but rather, splitting into harmful states and safe states. The more states like Maryland proactively protect their trans citizens, the more transgender people will be able to feel like allies have their back in a time when their care is consistently debated and comes under threat.