Colorado extends essential benefits of gender care to certain insurance plans

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DENVER – State and federal officials announced on Tuesday that more gender-affirming mental and behavioral health care and care would be covered as essential health benefits in individual and children’s health insurance plans Colorado groups starting in 2023.

The Centers for Medicare & Medicaid Services (CMS) announced approval of Colorado’s request to expand its essential health benefits to include more gender-specific care for LGBTQ + people, making the state the first of the countries to have such approved coverage, CMS Administrator Chiquita Brooks-LaSure told a press conference alongside Gov. Jared Polis, Lt. Gov. Dianne Primavera, Insurance Commissioner Mike Conway and Senator Brittany Pettersen , D-Lakewood, Tuesday morning.

Federal Government Endorses Colorado’s Inclusion of Gender Care in Critical Benefits Benchmarking

Additions to essential health benefit coverage in 2023 are highlighted by gender-affirming care, which will expand the services insurance companies need to cover beyond what they already include in this vein. .

“Coverage varies widely by insurance company and is not always comprehensive and may include explicit exclusions for certain services, even if a health care provider determines that a service is medically necessary,” the bureau said. of the governor in a press release.

CMS says the additional care that will be covered include eye and eyelid changes, facial tightening, facial bone reshaping, breast and chest reduction and construction, and laser hair removal.

“Colorado’s expansion of their essential health benefits to include gender-affirming surgery and other treatments is a role model for other states to follow and we invite other states to follow suit,” Brooks said. -LaSure in a press release.

Representative Brianna Titone, D-Arvada, who is Colorado’s first transgender lawmaker, said she was proud of Colorado’s decision to include more gender-affirming coverage.

“For too long, too many transgender and non-binary people have struggled to access the health care they need, despite having health insurance,” she said in a statement. “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.”

Other essential health benefits added to Colorado’s coverage by CMS include an annual mental health exam by a qualified mental health care provider, coverage of six annual acupuncture treatments to treat disorders related to the use of substances and the addition of 15 drugs that can be used as alternatives to opioids when doctors write prescriptions.

Polis and Conway, Colorado’s insurance commissioner, said the additional coverage would only increase costs by 64 cents per month for people on individual and small-group market plans, which they both said would be more than offset by the long term benefits.

The state said the new essential health benefit coverage would also apply to Colorado’s option plans when they go live for 2023. Officials said about 20% to 25% of Coloradans are covered by individual or small group health insurance plans.

Josie Nixon, development coordinator for Out Boulder County, which advocates for LGBTQ + people, services and programs, said the new benefits “show Colorado wants to lead the way.”

“Trans people will be able to access health care in Colorado more equitably. Suppliers will have more access to training because these things are going to become more common, ”Nixon said. “Right now, trans people face barriers like costs. It is incredibly expensive to try to self-fund these services. … People usually take huge loans, goFundMes go, and we would have to use GoFundMe or social media or our own resources to provide care to those residents that we have clinicians, psychiatrists and therapists who all say those – these are medically necessary for these people to thrive.

Nixon said they moved from Michigan to Colorado in order to feel more comfortable in the transition and have better access to health care. They paid most of the expenses out of their own pockets and said it crippled their mental health for a while, but it was the right decision in the long run.

“Without these changes and medical procedures that I went through, I don’t think I would be here today, and I think it’s important for people to recognize that access to health care improves a lot. different in our lives, ”Nixon added.

The last time Colorado changed its essential health benefits plan under the Affordable Care Act was in 2015. The state submitted its plan for 2023 in May after four months of discussions between a group of labor, consumers, insurance companies and health care providers.

“We’ve made great strides in making health insurance more affordable in Colorado, but it’s a big step in ensuring that the benefits of this insurance are more inclusive and meaningful,” Conway said in a statement.

The Colorado Association of Health Plans, which represents the health insurance industry, said it believes the new benefits, along with bills passed in the last session, will increase premium costs by 1 to 1. , 5% each year.

“This is not saving people money on health care and will make it even more unlikely that the premium reduction targets for the Colorado option will be met,” said Amanda Massey, spokesperson for the group. .

Representative Patrick Neville, R-Castle Rock, said the new covered benefits were “bad for the American worker” and amounted to “insurance mandates.”

“Policies like these will only increase costs for the Coloradans. They will increase the bureaucratic and regulatory burden on consumers, suppliers, employers and insurers. Employees will pay the price in the end, ”he said in a statement.


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