MaineCare Will No Longer Exclude Transgender Health Services From Coverage

Jun 20, 2019

The Maine Department of Health and Human Services announced an emergency ruling Tuesday removing transgender-specific health services from the list of non-covered procedures under MaineCare.

Quinn Gormley is the executive director of MaineTransnet, a support and advocacy group for transgender Mainers.

“It takes out the exclusions, so trans people under MaineCare can now try and get things covered. It doesn't specify what is covered yet. We have seen that there'll be a rulemaking process later in the year to specify exactly what it will and will not cover, and we look forward to being part of that process,” Gormley says. “But at the moment, this removes the first and largest barrier to getting transgender-health needs covered under MaineCare.”

Gormley says this is only the first step in obtaining health coverage for trans Mainers, and that details on what is covered by the plan will be developed later this year.

“What we've seen nationally and in other states is that plans are willing to cover things like hormone therapies, and some surgery for trans people, but they don't necessarily cover the full range of care needs around that care," Gormley says.

The Maine DHHS said in an email to Maine Public that the department will work to "establish criteria for covered services." The statement also said that the Affordable Care Act "prohibits sex discrimination in Medicaid" and "The courts have consistently found that federal sex discrimination laws, including this Section, prohibit discrimination against transgender people. Before this change, Maine was one of only 8 states left in the nation that maintained or enforced broad exclusions of transition-related health care in its Medicaid program."

The timeline for establishing criteria is not yet known. The state expects the fiscal impact to be minimal.

Update: 7:33 a.m June 20, 2019