New York State must remove restrictions on medically necessary healthcare for transgender Medicaid recipients under a decision issued late yesterday by a federal judge in Manhattan. Under the ruling, New York will be one of very few states where transgender individuals can obtain Medicaid funding for treatments that will bring their physical appearance in line with their gender. A trial will be held to determine to what extent coverage must be provided for transgender Medicaid recipients under the age of 18.
The decision came in Cruz v. Zucker, 14 Civ. 4456 (JSR), a class action lawsuit filed by The Sylvia Rivera Law Project (“SRLP”), The Legal Aid Society, and Willkie Farr & Gallagher LLP (“Willkie Farr”) on behalf of Medicaid-eligible transgender individuals diagnosed with gender dysphoria in the United States District Court for the Southern District of New York. In early 2015, the same case prompted the New York State Department of Health to amend a regulation, 18 N.Y.C.R.R. §505.2(l), adopted in 1998 by Governor George Pataki’s administration that had banned Medicaid coverage of all transgender care. As a result, in March 2015 the state began covering hormone therapy and gender-reassignment surgery for adults. But the revised regulation still excluded coverage for certain treatments deemed “cosmetic procedures”—such as facial feminization surgery, breast augmentation, and tracheal shaving— which experts in the case testified are medically necessary for some patients to reduce the acute distress and suicide risk associated with gender dysphoria. “This is an incredible victory for the transgender community. It is recognition that medical standards and the needs of individual patients should determine coverage, not the state’s designation of certain medical care as simply cosmetic,” said attorney Mik Kinkead of SRLP.
Read more at The Sylvia Rivera Law Project
