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Wisconsin: Medicaid to cover gender-confirming medical procedures

By Persephone Oliver |
December 17, 2019
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Kenosha, WI - As of December 10, Wisconsin is now one of the 20 states that cover medically necessary gender-confirming surgeries. People in need of these procedures will receive coverage under the state’s Medicaid healthcare plan. This development comes after state officials allowed the time frame to lapse for an appeal of the 2018 lawsuit that initiated the whole process.

This is undoubtedly a big win for transgender and non-binary people across the state and a huge rebuke to traditional thinking when it comes to transgender and non-binary individuals seeking surgery to help with gender dysphoria. Gender Dysphoria is a newer term defined by the Diagnostic and Statistical Manual of Mental Disorders’ (DSM) fifth edition (2013) as the distress a person feels due to a mismatch between their gender identity and their assigned sex at birth.

However, the movement for transgender and non-binary rights in Wisconsin and across the country can’t rest on this victory alone. Insurance companies are still a major gatekeeper for transgender and non-binary people. The struggle to take back and grow comfortable with our bodies sometimes but not always requires surgery.

The definition of what is medically necessary has been changing at a rapid pace since the 1960s. The earliest research in modern medicine has created a system of understanding that we are still rolling back today. The advent of the Kinsey model ranking the “level” a person is transgender and the misclassification of transgender people in the 1980s DSM-III have created lasting damage. The DSM-IV (2000) and DSM-V (2013) have made progress toward undoing the wrongs of the earlier flawed research.

There has been a push nationally for healthcare providers and health insurance companies to follow the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People. According to WPATH’s SOC the overarching treatment goal is “lasting personal comfort with the gendered self to maximize overall health, psychological well-being, and self-fulfillment.”

WPATH is a big proponent of the informed consent model. Medical providers are coming around to the idea of informed consent, which removes or diminishes the role of gatekeeping mental health professionals when considering hormone replacement therapy (HRT). It must be noted that it’s still important to discuss hormones and transition with a mental health provider before going on HRT. However, transgender people sometimes feel HRT is important for their gender congruence.

Despite this victory in Wisconsin, the issues of access to healthcare still remain. While we remove barriers to receive gender-confirming surgery, financial stability is a serious obstacle for those seeking surgery. Income inequality is a common reality for transgender and non-binary people. According to the American Psychological Association’s (APA) survey, transgender people are four times more likely to have a household of less than $10,000 per year compared to the general cisgender population. The APA also reports that 47% of transgender individuals have reported workplace discrimination in regards to hiring, firing and promotion. Another 25% have reported they had lost a job due to discrimination on the basis of their gender identity - two things which could easily be solved with raising the minimum wage and strengthening a worker’s right to organize a union.

Those who are lucky enough to have healthcare may still be subjected to a for-profit plan, which are prone to denying surgery. The private insurance market is still woefully behind on transgender and non-binary issues. Private for-profit insurances have been allowed to drag their feet on progress, relegating these surgeries to being fee-for-service. The laws mandating that insurance companies pay for these surgeries are subject to incredibly weak interpretation.

The movement in Wisconsin has taken a big step forward in creating a future for transgender and non-binary individuals to reclaim their bodies. Transgender and non-binary people are subject to much shame and humility on a daily basis. Victories that allow the reclaiming of our bodies are a fundamental step in our long term happiness. There still needs to be a major push to remove the for-profit healthcare model so we all can achieve adequate and necessary medical care.