Updates on Medicaid and Gender Confirmation

The hearing for lifting the ban on gender confirmation surgeries being covered by medicaid in Washington State will be happening in May. They are taking comments on it, which need to be in at 5:00 PM May 5th.


If you can show up, here is the time and address:
10:00 AM, Tuesday May 5th 2015
Health Care Authority
Cherry Street Plaza Building;
Sue Crystal Conf Rm, CSP 106B
626 - 8th Avenue, Olympia WA 98504

You can e-mail your comments, or snail mail them:
arc@hca.wa.gov

HCA Rules Coordinator
PO Box 45504,
Olympia WA, 98504-5504


And here is the link I am following where updates are posted:

http://www.hca.wa.gov/rulemaking/Lists/RulemakingActivity/DispForm.aspx?ID=73

Right now, that's the only place to find any information on what's happening with this.


The proposed rule with its changes has been posted. I am going through it and making an abridged version with just what is covered, and a bit of other helpful info. For now, here is the proposed rule as is:

http://www.hca.wa.gov/rulemaking/Documents/102-15-08-100.pdf

Procedures covered/not covered by Washington State Medicaid

(I edited and organized the original document. Bold, underline, and italics were added by me. Notes from me are in italics
Here's the original: http://www.hca.wa.gov/rulemaking/Documents/102-15-08-100.pdf )


1. HOW THE HCA ORGANIZES THE STAGES OF TRANSITION

The agency's gender dysphoria treatment program has four stages. Prior authorization is required for stage four only. Any medicaid provider can refer a client to stage one. The stages are as follows:

Stage one - Initial assessment and diagnosis of gender dysphoria;
Stage two - Mental health and medical treatment;
Stage three - Presurgical requirements; and
Stage four - Gender reassignment surgery.

2. SUMMARY OF WHAT MEDICAID WILL COVER

Medicaid will cover these (But not just these)

-Presurgical and postsurgical hormone therapy;
-Prepuberty suppression therapy;
-Mental health services;

-Surgical services including, but not limited to:
-- Anesthesia;
-- Labs;
-- Pathology;
-- Radiology;
-- Hospital; and
-- Physician services.

3. WHAT IS/ISN'T COVERED (IN STAGE 4)

COVERED

- Bilateral mastectomy;
- Cliteroplasty;
- Colovaginoplasty;
- Colpectomy;
- Genital surgery;
- Genital electrolysis as required as part of the genital surgery;
- Hysterectomy;
- Labiaplasty;
- Metoidioplasty;
- Orchiectomy;
- Penectomy;
- Phalloplasty;
- Placement of testicular prosthesis;
- Salpingo-oophorectomy;
- Scrotoplasty;
- Urethroplasty;
- Vaginectomy; and
- Vaginoplasty.

NOT COVERED

- Abdominoplasty;
- Blepharoplasty;
- Breast augmentation;
- Brow lift;
- Calf implants;
- Cheek/malar implants;
- Chin/nose implants;
- Collagen injections;
- Drugs for hair loss or growth;
- Facial or trunk electrolysis, except for the limited electrolysis (described elsewhere)
- Facial feminization;
- Face lift;
- Forehead lift;
- Hair transplantation;
- Jaw shortening;
- Laryngoplasty;
- Lip reduction;
- Liposuction;
- Mastopexy;
- Neck tightening;
- Pectoral implants;
- Reduction thyroid chondroplasty;
- Removal of redundant skin;
- Rhinoplasty;
- Suction-assisted lipoplasty of the waist;
- Trachea shave;
- Voice modification surgery; and
- Voice therapy.