Home » Some Gender-Affirming Care Barriers Eliminated in Colorado Medicaid Policy

Some Gender-Affirming Care Barriers Eliminated in Colorado Medicaid Policy

New requirements intended to improve access for gender-expansive people.

People receiving gender-affirming care through Colorado’s Medicaid program will face reduced barriers to care when changes in the state’s coverage policy take effect at the end of August. 

Colorado’s Office of Health Care Policy and Financing updated policy language in the state’s Medicaid program, known as Health First Colorado, around gender-affirming care to bring it in line with modern standards for the various procedures and treatments covered. The updates adopted by HCPF’s Medical Services Board in mid-July removed certain requirements around mental health treatment and hormone levels before surgical procedures, among other changes. The new policy takes effect on Aug. 30. 

Skylar Patron, health equity manager at One Colorado, an advocacy organization for LGBTQ people, said the new policy language gives gender-expansive people more autonomy over their own journey without interference from their insurance. 

“Previously, to access gender-affirming hormone therapy, someone needed to be receiving mental health counseling, and that is no longer a requirement,” Patron said. “We know that being trans or gender expansive is not a mental illness, so that’s something we’re really excited to see.” 

The updates to Colorado’s Medicaid coverage of gender-affirming care will help reduce wait times for people trying to access care when providers are limited, Patron said. They also expect to see fewer insurance denials for people waiting for care under the new requirements, as well as a reduced administrative burden on Colorado’s providers.

“They’re really hopeful that the amount of surgeries that get delayed will be reduced because of insurance reasons and that the number of people who are able to access care will go up,” Patron said about health care providers offering gender-affirming care.

Another change Patron highlighted is that patients will no longer need two letters from a doctor before they can receive gender-affirming surgery. Currently, the letters need to be dated within 60 days of the scheduled surgery, and this requirement can be difficult to meet with scheduling changes. 

Adela Flores-Brennan, HCPF’s Medicaid director, said the department is proud to modernize its rules for gender-affirming services. 

“We are confident that these updates will help improve equitable access to care for the transgender and gender-diverse community, and we are grateful to our partners for their collaboration and advocacy in creating A Colorado for All,” Flores-Brennan said in a statement. 

While One Colorado doesn’t have recent data after the coronavirus pandemic, data from 2018 showed that 1 in 5 transgender people in Colorado are enrolled in Health First Colorado. 

“We’ve heard from our partners working clinically in health care right now that the vast majority of their patients are utilizing Medicaid who are accessing gender-affirming services,” Patron said. “So they’re really excited that this will have a huge impact on the majority of their patients currently.”

As some anti-trans activists target trans rights and access to gender-affirming care across the country, Patron said Colorado continues to prove itself as a sanctuary state. But they reiterated that just because access to health care is protected doesn’t mean it is accessible, and the updates Colorado made to its Medicaid policy will help remove barriers to make it more accessible. 

“We can continue to move Colorado forward in this way, especially when in our neighboring states, there’s really nowhere to access gender-affirming care,” Patron said. “So it’s really important that Colorado is leading in this way, and especially that Colorado’s Department of Health Care Policy and Financing is willing to work with community and stakeholders to make sure that they’re getting it right and following best practices.” 

At least 70 anti-LGBTQ laws were enacted this year, with 15 of those laws targeting gender-affirming care for transgender youth and seven allowing or requiring the misgendering of trans kids at school, according to the Human Rights Campaign. States have also passed anti-LGBTQ bills limiting how LGBTQ people can be mentioned in school curricula and criminalizing some drag performances. Colorado lawmakers recently expanded transgender protections.

Colorado’s Medicaid does not have an open enrollment period, so people can enroll anytime throughout the year.