American Society of Plastic Surgeons
For Consumers

CO, IA & WA: Protect Gender Confirmation Coverage

While the Society has seen an increase in the number of gender-confirming surgeries in recent years, there also has been a significant increase in debates by states across the country about the need for gender confirmation coverage and access to medically necessary services. ASPS firmly believes that plastic surgery services can help gender dysphoria patients align their bodies with whom they know themselves to be and improve their overall mental health and well-being. The Society advocates across state legislatures, including Colorado, Iowa and Washington, for full access to medically necessary transition care.

In May, ASPS submitted a letter to the Colorado Medical Services Board in support of a proposed rule that would allow full coverage of permanent hair removal for transgender individuals. The Society applauded the Agency for recognizing that hair removal procedures are an important step in the patient's overall care as it helps the patient achieve an identity that aligns with their true gendered self. ASPS offered to continue to work with the agency as it finalizes this proposal in the rulemaking process.

Sadly, in Iowa, lawmakers attached a last minute-amendment to the Health and Human Services appropriations bill, which would prohibit the state from providing coverage for gender-affirming surgical procedures to transgender individuals. This measure was a direct threat to the recent progress made by the Iowa Supreme Court after it unanimously overruled the state's prohibition of Medicaid coverage for gender-affirming surgery. ASPS quickly mobilized against this discriminatory bill provision by submitting comments to newly-elected Governor Kim Reynolds urging her to line-item veto the bill and remove this provision. Unfortunately, Governor Reynolds ignored the Society's request and signed the coverage prohibition provision into law on May 3, 2019.

However, ASPS's lobbying efforts to defeat a similar measure in Washington proved to be successful in April. After ASPS and the Washington Society of Plastic Surgeons submitted two rounds of comments in 2018 in opposition to the Washington Health Care Authority's proposed rules on gender dysphoria treatment services, the rules were formally withdrawn on April 16, 2019. This was a huge victory for the societies and the patients they serve because, if adopted, these rules would have reclassified certain gender confirming surgeries as noncovered services – creating a new barrier to transition care in Washington State.