This month marks LGBTQ+ Pride Month, which celebrates perseverance in the fight for the rights of LGBTQ+ Americans. This year, the equality, safety and health care of transgender communities is under attack. In the face of threats to gender-affirming care access, Health Care For All continues to stand by transgender people in Massachusetts and fight for equal access to health care. Medicaid in Massachusetts, known as MassHealth, currently covers a wide range of gender-affirming care. This coverage exists, in part, thanks to the Mass Trans Health Coalition who fought to expand MassHealth services in 2014 and 2021. However, current attacks on gender-affirming care at the federal level threaten the progress that has been made here in Massachusetts.
4 Major Current Attacks on Gender-affirming Care
- Ban on gender-affirming care for youth: In the first few days of his administration, Trump issued an executive order banning all gender-affirming care for young people, 19 years old and younger. Massachusetts Attorney General Andrea Joy Campbell, along with 14 other states’ attorneys general, issued a statement against the executive order, reaffirming pre-existing Massachusetts law which protects access to gender-affirming care. This leaves pediatric gender-affirming care providers in a confusing position, caught between the executive order and the state law.
- HHS endorses conversion therapy for trans youth: In an in-depth review of gender-affirming care practices for youth, the Department of Health and Human Services (HHS) condemned the use of previously approved medical treatments for Gender Dysphoria, while endorsing psychotherapy that is aimed at making patients identify as their assigned sex at birth, otherwise known as conversion therapy. Psychiatric experts report that conversion therapy is harmful to youth and should not be part of any behavioral health treatment of children and adolescents. Massachusetts law currently prohibits sexuality or gender conversion therapy for minors. While HHS’s report does not make policy recommendations, it is dangerous and risks spreading misinformation about gender-affirming medical care while holding up harmful practices for children as proper mental health care.
- US v. Skrmetti Supreme Court decision: Last week, the US Supreme Court ruled in favor of the Tennessee law banning gender-affirming care for youth under 18 years old. In Massachusetts, gender-affirming care is still protected for youth, but many other states have already banned this life-saving care for young people. So far, 26 states have passed legislation banning some or all gender-affirming care for youth, which affects almost 40% of trans youth or 118,300 young people whose care will be limited. There is already a limited number of affirming medical providers in the country, and these bans will further strain those providers and resources in states like Massachusetts which protects trans youth and their medical care.
- Medicaid cuts of gender-affirming care coverage: Congress is currently considering making the largest cuts to Medicaid in the program’s history, which explicitly includes preventing federal funding for Medicaid and CHIP coverage of all gender-affirming medical treatment. Transgender people are nearly twice as likely to rely on Medicaid than straight cisgender adults and would be severely impacted by these potential cuts – preventing them from obtaining care at all in many cases. If the proposal passes, MassHealth’s ability to continue to fund these services, while maintaining expanded eligibility and many other services, could be severely limited.
What To Do About It!
While there is little to do about the HHS endorsement and US v. Skrmetti decision right now, it’s not too late to stop the Medicaid cuts for gender-affirming care and other critical services. Health Care For All is working with partners to try to prevent these cuts in a variety of ways, including hosting Medicaid Defender phone banks. Through partnerships and advocacy, Health Care For All will continue supporting transgender communities in Massachusetts and their ability to make their own health care decisions, during Pride month and every month.
Transgender Health Resources:
- MassHealth Coverage for Gender-affirming Care: https://www.mass.gov/info-details/gender-affirming-care-covered-by-masshealth
- MA Trans Health Coalition: https://www.masstpc.org/what-we-do/ma-trans-health-coalition/
- Health Law Advocate’s Transgender Health Care Access Project: https://www.healthlawadvocates.org/initiatives/transgender-health
- NAMI Massachusetts Resources for the LGBTQ+ Community: https://namimass.org/resources-for-the-lgbtq-community/#!/the-community
- GLAD Legal Advocates and Defenders: https://www.glad.org/know-your-rights/
Sam Chanen is a practicum student at Health Care For All studying at Harvard’s Chan School of Public Health.
