SAN FRANCISCO — California’s Department of Managed Health Care (DMHC) has issued guidance clarifying the obligations of California’s health plans under the Insurance Gender Nondiscrimination Act. In a groundbreaking directive to health plans, the DMHC confirmed that California’s Insurance Non-Discrimination Act of 2006, authored by former Assemblymember Paul Koretz, guarantees all people the right to access coverage for medically necessary care regardless of their gender identity or gender expression. The directive also provides that patients who are denied coverage can appeal the decision for review by the Department.
Speaker Pérez said,“This is an important step in protecting the health of all Californians, including transgender individuals. No Californian should be denied care and treatment because of their gender identity or expression. Implementation of California’s Insurance Gender Nondiscrimination Act (IGNA) is a simple matter of fairness and equality in health care. I commend the Department of Managed Health Care for issuing its Director’s Letter reminding health care service plans of their obligation to comply with IGNA.”
“This one letter will save lives,” said Masen Davis, executive director of Transgender Law Center. “For years, transgender Californians have been denied coverage of basic care merely because of who we are. Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.”
The DMHC directive applies to HMOs and PPOs regulated by the Department of Managed Health Care. In 2012, the Department of Insurance issued non-discrimination regulations with similar protections for health insurance regulated by the Department of Insurance. Combined, this means that all California health plans and insurers cannot arbitrarily deny medically necessary services provided to other policy holders or members simply because the patient is transgender.
The newly issued DMHC letter instructs health plans to revise current plan documents to remove exclusions and limitations related to gender transition. For transgender people, how and when they transition is typically a private decision made with their doctor. The American Medical Association, American Psychological Association, American Psychiatric Association, and the American Academy of Family Physicians have all deemed transition-related care to be medically necessary for transgender patients.
A 2008 study conducted by Transgender Law Center found that an alarmingly high rate of transgender patients were denied coverage for essential health care. 15% were outright denied gender-specific care such as pap-smears or prostate exams just because they were transgender.
