N.H. Lifts Ban on Medicaid Coverage for Sex Reassignment Surgery

Oct 20, 2017

New Hampshire’s Medicaid program will no longer ban insurance coverage for sex reassignment surgery.

Until now, New Hampshire's Medicaid program explicitly blocked such coverage. The Department of Health and Human Services asked lawmakers for permission to take out the language, citing anti-discrimination mandates within the Affordable Care Act. 

DHHS says it identified about 100 people (out of about 187,000) in the last five years of Medicaid data with a diagnosis of gender identity disorder, but said it is " unable to determine how many of these individuals would pursue gender reassignment surgery, or for how many such surgery would be deemed medically necessary." 

DHHS Commissioner Jeff Meyers says this change was already factored into the rate changes the state negotiated with the managed care companies for the year ahead. In total, the anticipated change added about $286,000 to those contracts, split evenly between state and federal funds.

While the measure ultimately passed, Thursday’s hearing drew extended testimony from opponents who questioned both the medical legitimacy of sex reassignment surgery and the idea that state Medicaid money should pay for the procedure. Some opponents also argued the procedure should not be covered for anyone under the age of 18.

But supporters like Toni Maviki, who went through the surgery herself, urged lawmakers not to let misconceptions about the procedure cloud their vote. A former law enforcement officer, Maviki teaches classes on  

“Education is the key,” Maviki said. "One of the things that I've heard here today is people's lack of knowledge about the issue, because they don't have adequate education.”

Pushing back on some of the claims aired at the hearing, Maviki and other supporters of the rules change said the surgery is only done after thoughtful and extensive consultation with medical professionals.

In the end, the rules panel decided that the health department was within its authority to change its rules, based on federal guidelines.

Linds Jakows who leads the transgender advocacy group Freedom New Hampshire, was encouraged by the vote.

"I am really really thrilled, as a nonbinary transgender person myself, that transgender Medicaid recipients will no longer be categorically excluded for no reason for care that doctors have deemed to be medically necessary,” Jakows said.