Biden admin allows Colorado to make gender-affirming care an essential health benefit

The Biden administration has given Colorado the green light to include coverage for gender-affirming care in its essential health benefits packages in Affordable Care Act exchange plans.

The Centers for Medicare & Medicaid Services (CMS) said this aligns with the White House's broader goal of addressing health disparities, in this case by working to remove barriers to care for transgender patients. 

Colorado's approach discourages a "one-size-fits-all" approach to transgender care, CMS said in an announcement, and would allow access to a greater range of benefits than many currently can receive. Treatments available will include eye and lid modifications, facial tightening, facial bone remodeling for facial feminization, breast and/or chest construction and reduction and laser hair removal.

Essential health benefits in Colorado's benchmark plan will also include mental health care access and coverage for 14 prescription drug classes, CMS said.

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"Health care should be accessible, affordable and delivered equitably to all, regardless of your sexual orientation. To truly break down barriers to care, we must expand access to the full scope of health care, including gender-affirming surgery and other treatments, for people who rely on coverage through Medicare, Medicaid & CHIP and the Marketplaces," said CMS Administrator Chiquita Brooks-LaSure in a statement.

"Colorado's expansion of their essential health benefits to include gender-affirming surgery and other treatments is a model for other states to follow and we invite other states to follow suit," she said.

Physician organizations including the American Medical Association and the American Academy of Family Physicians consider gender-affirming care to be a "standard level of care," CMS said.

The ACA mandates that qualified health plans offered on the exchanges cover a suite of 10 essential benefits, including preventive and wellness services, chronic disease management, maternity and newborn care, hospitalization, prescription drugs, mental health and substance use disorder services, behavioral health treatment and lab services.

States have the flexibility to develop their own "benchmark plans" to modify these packages.