Medicaid Expands Coverage For Transgender Oregonians

Alex Paige, a trans woman from Portland, describes the gender dysphoria she experienced as “a supreme unhappiness with the way my body looked, the way it felt, the way other people interacted with me.” Thanks to an Aug. 14 vote by the Health Evidence Review Commission (HERC), treatments for gender dysphoria will be covered under the Oregon Health Plan (OHP) beginning January 2015.

The vote followed an intensive study by HERC of the effectiveness of treatments for gender dysphoria — the complex condition people feel when their bodies don’t agree with their gender identities.

This new “continuum” of covered treatments, which Basic Rights Oregon policy director Danielle Askini says will “save lives and money,” will encompass therapy, hormonal treatment, puberty suppressants and reassignment surgery. HERC predicts that 175 transgender people will utilize these treatments per year.

In a National Center for Transgender Equality (NCTE) survey of transgender Oregonians, 44 percent reported that they had attempted suicide. Askini says that this coverage expansion is based on two things: the evidence that suicide rates in transgender people plummet after they are given proper treatment and the logic that money spent on treatment now will be far less than that spent on lifelong psychological therapy or emergency room visits following suicide attempts.

Now that she is comfortable with her gender identity and receiving hormonal treatment, Paige says she dresses how she wants, never gets “mis-gendered” and generally lives her life. The one step she hasn’t taken is gender reassignment surgery, which she would do if she could afford it. Although Paige’s reassignment surgery will technically be covered in January, there is only one gender reassignment surgeon in Oregon, and he doesn’t accept OHP insurance.

Representatives from Basic Rights Oregon and OHP say they are not immediately clear on how Oregonians insured under OHP will access dramatic “bottom surgeries” like vaginoplasty. Askini thinks Oregon may do something similar to Washington, where the state’s version of Medicaid arranges for patients to undergo their surgeries in California.

“A barrier for low-income folks is now removed, and that is huge,” says Allison Cleveland, who helps lead the Oregon Anti-Violence Project in Eugene, “because in previous years if you were financially able, you could get the care that you needed.” Cleveland has seen clients travel as far as Thailand for cheap, imperfect reassignment surgery, returning still alienated from their bodies.

According to the NCTE survey, 17 percent of transgender respondents had an annual income of $10,000 or less. Cleveland believes that cheaper access to treatments from OHP will be a blessing for all transgender people, from kids hoping to prevent a puberty they don’t want, to adults finally assuming fully functional genitalia that they’re comfortable with.

Paige says suicide rates shouldn’t be the only thing considered to rationalize increased access to transitional hormones and surgery. “There are times when you just are completely tired of feeling in pain and feeling hurt and you just want to give up. Usually you’re just struggling to survive every day. A big part of my transition was realizing — survival isn’t enough. You have to be able to live as well.”