Medicaid to now provide coverage for gender affirming surgeries

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SPRINGFIELD, Ill. — Gov. J.B. Pritzker on Friday ordered Illinois’s Medicaid program to begin covering gender affirming, or gender reassignment surgeries.

The Illinois Department of Healthcare and Family Services is starting to develop administrative rules to offer this coverage. Input from stakeholders and the public will be considered during the public comment period.

“Healthcare is a right, not a privilege, and I’m committed to ensuring our LGBTQ community and all Illinoisans have access to that right,” said Pritzker. “Expanding Medicaid to cover gender affirming surgeries is cost effective, helps avoid long term health consequences, and most importantly is the right thing to do. With continued attacks coming from Washington, this administration will always stand with our transgender community and their right to lead safe and healthy lives.”

IDHFS said it anticipates coverage  becoming available to Medicaid members upon adoption of the administrative rule, which will likely be this summer. 

“For those facing gender dysphoria, every day can be a painful challenge,” said Theresa Eagleson, director of HFS. “Helping these individuals overcome their struggles through compassionate and comprehensive treatment is the right approach for them and for Illinois. They may not be a major portion of our total Medicaid membership, but the coverage can be so vital for everyone confronting this.”

The new policy will include Medicaid members in HealthChoice Illinois, the state’s managed care program, as well as those receiving their care through traditional fee-for-service. Under the proposed coverage rules, Medicaid members age 21 and older who are diagnosed with gender dysphoria will now be eligible for genital and breast-related surgeries. 

In studying other state policies, the HFS said gender affirming surgery is cost-effective and can help prevent negative health impacts, including depression and suicide.

The HFS said 17 states and Washington, D.C. also offer these services and have not reported significant cost increases. The most recent data available shows that 1,400 of the state’s 3.1 million Medicaid members are diagnosed with gender dysphoria, and last year around 2,500 prescriptions for hormone therapy were covered.

The ACLU of Illinois applauded the new rules. 

“We welcome Governor Pritzker’s announcement that Illinois will cover gender affirming surgery under its Medicaid program. This is a crucial step to respond to the health care needs of all Illinois residents, including those who are transgender,” ACLU of Illinois LGBTQ & HIV Advocacy Director said. “By putting an end to this outdated exclusion on gender affirming surgery, Illinois now joins a long and growing list of states providing coverage for this critical, life-saving health care. We applaud the governor for making this important step forward.”

The announcement comes after International Transgender Day of Visibility, which is observed on March 31.

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