Biden signs off on Colorado’s expansion of transgender-related health coverage

Under a groundbreaking decision by state and federal officials, many private health plans sold in Colorado will soon be required to cover hormone therapy, genital reconstructive services and other procedures sought by transgender patients.

The change, which would take effect on Jan. 1, 2023, would mark the first time the federal government has approved a requirement for transition-related coverage in individual and small-group health plans. More than a dozen states, including Colorado, already cover such services in their Medicaid plans.

Biden officials cited discrimination facing transgender patients and predicted the Colorado decision would serve as a road map for other states seeking to broaden such coverage. They also said the approval helps fulfill the president’s campaign pledge to expand access to coverage for LGBTQ Americans, including requiring insurers to cover care related to transitions.

“Colorado’s taking a very important step,” Health and Human Services Secretary Xavier Becerra said in an interview. “Transgender [people] face discrimination on a constant basis. And it is, to some degree, intensified by the inability for transgender Americans to get the health-care services they need.”

Tuesday’s announcement is the latest in a series of Biden administration decisions to codify policies sought by LGBTQ Americans, including a May 2021 announcement to broaden anti-discrimination protections for transgender patients. The Trump administration narrowed access to those protections.

Colorado Gov. Jared Polis (D), Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure and other officials announced the policy in Denver on Tuesday. The new coverage for transition-related procedures, which was authorized under a Trump-era policy that allows states to request modifications to their health insurance markets governed by the Affordable Care Act, would require Colorado health plans to provide “gender-affirming care” among the essential benefits guaranteed to their customers.

“We hope this marks a historic beginning, and that other states look to Colorado as a model,” Brooks-LaSure said. “We invite other states to follow suit.”

The decision was cheered by patient advocates, but panned by some conservatives, who challenged the evidence supporting it, and argued the administration’s move is inappropriate.

“This is a liberal administration and governor colluding to mandate coverage for a lifetime of cross-sex hormones and removal of healthy organs, including for minors,” said Roger Severino, a former Trump appointee who served as the health department’s civil rights chief. “Their end game is clear, to push these dangerous experimental treatments on kids and unwilling families as a national insurance mandate.”

Some transgender patients have detailed the challenges they face obtaining costly services like hormone therapy, saying that interruptions or delays in care can lead to long-lasting setbacks in their transitions. A November 2020 study by Out2Enroll, an organization that helps the LGBTQ community obtain health insurance, found that most plans sold through the government’s health insurance website,, failed to specify whether they covered care for transgender patients. In 7 percent of cases, health plans explicitly excluded procedures for transgender patients, Out2Enroll found.

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