Now that Massachusetts has protected gender-affirming care, it’s time to actually make it accessible.
Last month, Governor Charlie Baker signed legislation that provides critical protections for abortion care and essential health care for transgender people in the Commonwealth. While gender-affirming care is now legally protected statewide, a momentous task lies ahead: Access to gender-affirming care. Even in Massachusetts, it remains incredibly rare, and this must change.
Oftentimes insurers will require patients to change their primary care provider or pediatrician to access services because they allow patients to be assigned to only one primary care provider. This creates an immediate barrier. Many patients understandably do not want to change primary care providers, especially if they have an established relationship with their practice; nor should anyone be required to in order to obtain health care.
In addition to increasing payments for gender-affirming care through MassHealth, the state can also expand care by taking two simple steps. First payors — commercial insurers, accountable care organizations, MassHealth — could provide certain services as specialty care. Second, insurers could pay for consulting clinical services. Implementing either model would give patients the choice to stay with their primary provider while accessing gender-affirming care.
Under a specialty model, a patient could remain with their primary care provider and obtain services — such as hormone therapy — with another skilled provider. Moreover, many within the trans and gender-diverse community present with high levels of trauma and complex psychological difficulties, and this model would provide increased incentive for delivering comprehensive mental health care. And the stakes could not be higher. Over 53 percent of trans and gender-diverse youth have considered suicide in the past year, according to a 2022 survey by the Trevor Project, and the most recent national transgender survey reported that more than 50 percent of trans adults had attempted suicide.
Under a consulting model, a patient could remain with their primary care provider — and if the provider did not have experience in a specific area, they could consult with an expert who would give support in the delivery of quality care outside of their own experience. There is precedent for this, such as the successful Massachusetts Child Psychiatry Access Program model, which was created in 2004. This program is supported through the state budget and helps all frontline providers identify and address the mental health and substance use concerns of their pregnant and postpartum patients. A similar program could be developed for gender-affirming care.
It is essential health care and should be integrated into all forms of care. However, recent data show that there is woefully insufficient access to this life-saving coverage statewide. If the state is truly dedicated to protecting all of its patients, it must also think strategically.
MassHealth has led the way in increasing access for trans and gender-diverse individuals by issuing medical-necessity guidelines to expand coverage, and by increasing the number of services it covers as well as the reimbursement rates for those necessary services. It can now do more by allowing gender-affirming providers to be considered specialty providers and consult when needed.
The Division of Insurance oversees commercial insurance and has had a history of listening to the needs of the trans and gender-diverse community. This presents another opportunity for DOI to encourage insurers to allow for these or similar models.
Everyone has a unique relationship with their gender. Trans and gender-diverse people know this intimately and deserve to live their fullest lives. Now is the time for Massachusetts to continue to lead the way and fight for an expansion of access that our communities so desperately need.