The U.S. Department of Health & Human Services (HHS) has clarified that the reform law, which prohibits insurers from discriminating based on sexual orientation, applies to transgender people, reported Kaiser Health News.
In a recent letter to the National Center for Lesbian Rights, HHS said it is a discriminatory act for insurers and employers to deny health insurance to consumers based solely on "gender identity or failure to conform to stereotypical notions of masculinity or femininity," including transgender people who identify themselves with a different sex than the one they were born with.
However, insurers still aren't obligated to cover members' surgeries related to gender transition, HHS said in a statement posted online. The agency said it plans to issue further guidance on the transgender subject, noted KHN.
The HHS clarification piggybacks court decisions and an Equal Employment Opportunity Commission ruling that sex discrimination applies to transgender people. In May, Aetna reimbursed a transgender female for a mammogram that the insurer originally claimed fell under an exclusion treatment policy "related to changing sex," FierceHealthPayer previously reported.
HHS also said it's accepting and investigating sex discrimination complaints brought under the reform law. If it determines sex discrimination occurred, it can impose several actions, including withdrawing federal financial assistance.
"This is a population that's very underserved and in need of a lot of healthcare," M. Dru Lavasseur, a transgender rights attorney for advocacy group Lambda Legal, told KHN. Transgender patients often undergo surgery to reconstruct genitals, reduce the chest or contour the face and often need hormone therapy, mental health counseling and short-term leave from work.