Colorado Becomes First in US to Require Insurance Plans Cover “Gender Affirmative Care” | New


Colorado is becoming the first state in the country to make gender services an insurance mandate.

Gov. Jared Polis, joined by state and federal officials, announced on Tuesday that “gender-affirming care” and drug treatment will be added as essential health benefits to Medicare for small groups and individual markets, effective January 1, 2023.

Insurance Commissioner Michael Conway has estimated the cost of additional premiums for these services at around 64 cents per person.

Gender-affirming care is defined as “mental and physical health services that help align a transgender person’s body with their gender identity,” according to the Polis administration.

The additional benefits were approved by the Biden-Harris administration, according to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS), who joined Polis for the announcement.

Brooks-LaSure said, “Gender-affirming care can save lives. By making this care essential, the referral plan will guide what is included in statewide health coverage. This expansion is a role model for other states to follow and we invite other states to follow suit … we are proud to support Colorado as it takes this step towards health equality. “

An essential health benefit is a service that a health insurance company is required to provide under the Affordable Care Act. There are 10 categories of essential health benefits, including outpatient services, emergency services, hospitalization, mental health and substance use disorder services, pregnancy care, prescription drugs, laboratory work and rehabilitation services.

The individual and small group health insurance markets cover about 20% of Colorado residents, according to Conway.

The addiction treatment added as a benefit on Tuesday focuses primarily on opioid addiction. Senator Brittany Pettersen, D-Lakewood, who sponsored several behavioral health bills during the 2021 session that were enacted, told the press conference that annual mental health reviews were not historically not covered by insurance companies. In July, Polis enacted House Bill 1068, which requires insurance companies to pay for an annual mental health exam.

“This is a big step forward for parity,” said Pettersen. It is important that people do these tests before they engage in drug use for self-care for anxiety or depression.

Alternatives to opioids are one of them, Pettersen said. Doctors have over-prescribed opioids for pain management, and there is much that can be done to change the culture after decades of over-prescription. Doctors said opioids are the only pain treatment covered by insurance, Pettersen said. “It is unacceptable,” she said. It will be significant for a third of Colorado’s population, allowing doctors to seek alternatives and provide patients with the care they need, with no lifelong consequences, Pettersen added.

Conway said the benefits of gender-affirming care will be more inclusive and meaningful for LGBTQ + Coloradans.

These services may include:

  • cheek, nose and chin implants
  • lip augmentation
  • creating or increasing the angle of the jaw
  • laser electrolysis and hair removal

As for the cost, Polis said he had to be convinced the savings would outweigh the cost of those benefits. Opioid addiction is a key area of ​​behavioral health where cost reduction is imperative. This includes the human as well as the financial cost, he said, such as loss of income, loss of jobs and income, tearing apart families and even homelessness. Preventing this, by offering alternatives to pain management and recovery, saves money on healthcare, he said.

State Representative Brianna Titone D-Arvada, Colorado’s first transgender lawmaker, was among the sponsors of the annual mental health exam act. She said in a statement Tuesday that “Every person deserves to have access to the full range of health services they need, and I am proud that Colorado is leading the way in full coverage of care for LGBTQ + people in the world. our state. For too long, too many transgender and non-binary people have struggled to access the health care they need, despite having health insurance. These services are essential for the health and safety of LGBTQ + communities and will provide more Coloradians with the agency they need to assert their identity.

Polis went back and forth on his perspective on insurance mandates. He vetoed a mandate bill in 2020, warning lawmakers to stop sending him bills that could increase health insurance premiums at a time when his administration had pledged to reduce the cost of healthcare. ‘Health Insurance. But he has since signed several other insurance mandates.

The addition of new benefits has been in preparation since January, although the assumption of responsibility for gender affirmation was not discussed by the General Assembly as a possible new insurance mandate.

In a statement to Colorado Politics, the Colorado Association of Health Plans said it fully supports “ensuring that all Coloradans have access to high-quality, affordable care. However, with additional benefits come additional costs. which, by law, must be reflected in the price of premiums. CAHP estimates that the new benefits of the 2023 benchmark regime, in addition to the bills passed by the General Assembly in 2021, will cost Coloradians 1 to 1, 5% more for their annual premiums. This will not save money on health care and will make meeting premium reduction targets for the Colorado option even more unlikely. “

CAHP made the same point to Conway in an April letter.

“The CAHP would like to note that there is variation between the estimates of individual and small group ACA carriers in Colorado and the estimates of Wakely (the actuarial firm used by the state),” wrote the CAHP. “These differences raise concerns for the CAHP that the proposed EHB benchmark does not equal a typical employer plan and exceeds the generosity of the most generous of a set of comparison plans discussed in the Wakely report.”

The members of the CAHP believe that the impact of the proposed changes to services is as follows:

Estimates of how much new essential health benefits would drive up insurance premiums, both from Wakely, used by the state; and the Colorado Association of Health Plans. Courtesy of ACHA.

The letter continued: “ACHP members are also concerned that cost estimates have not been provided for all proposed changes to the benefits of the EHB Reference Plan. For example, the Wakely report notes that mental health services that are prison or residential in nature should be included in the EHB referral plan under the guise of mental health parity, even though child care and accommodation services not related to mental health are generally not covered by health insurance. ask CMS. Removing this exclusion and requiring insurers to cover mental health and residential care could have a significant impact on the actuarial value of the EHB benchmark plan and on Colorado consumer premiums. “


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