LGBTQ+ Care is an Essential Health Benefit in Colorado

LGBTQ+ Care is an Essential Health Benefit in Colorado

One Colorado, the state’s leading advocacy organization for lesbian, gay, bisexual, transgender, and queer (LGBTQ) Coloradans commends Biden-Harris Administration and the Centers for Medicare & Medicaid Services (CMS) for their approval to provide gender-affirming care in the individual and small group health insurance markets as part of Colorado’s Essential Health Benefit (EHB) benchmark, a life saving and innovative update that would not have been possible without the leadership of the Colorado Division of Insurance and Commissioner Conway.

We know that LGBTQ Coloradans often face a myriad of challenges and barriers to achieve a healthy life. While LGBTQ individuals have many of the same concerns as the general population–like affordability, access, and quality of care–they also encounter unique challenges that affect their ability to live healthy, affirmed lives. Lack of understanding, discrimination, stigma, violence, higher rates of health problems, as well as other barriers compound to produce worse health outcomes. Over the past decade, One Colorado has worked to address these issues through policy and advocacy, community engagement and improving data collection and research on the experiences of LGBTQ Coloradans accessing health care. In doing so, we have supported Colorado to become the national standard for gender-affirming care.

Today we affirm the Centers for Medicare & Medicaid Services in their findings that “expanded, gender-affirming coverage vastly improves health care outcomes for the LGBTQ+ community, reduces high rates of depression, anxiety, and suicide attempts as well as decreases substance use, improves HIV medication adherence, and reduces rates of harmful self-prescribed hormone use.” According to our most recent LGTBQ health report data, Closing the Gap: The Turning Point for LGTBQ Health

  • 41% of transgender respondents have contemplated suicide,
  • 84% of transgender respondents said having resources to cover out-of pocket health expenses is a barrier, 
  • 84% of transgender respondents reported there were not enough adequately trained mental or behavioral health providers, and 
  • 85% of transgender respondents reported there were not enough health professionals adequately trained. 

One Colorado’s Health Equity and Training Director Marvyn Allen shares: “Based in our own research, we know that gender-affirming care is vital to the mental health of transgender and nonbinary Coloradans. For too many, gender-affirming care is unaffordable and unattainable. Transgender Coloradans, especially trans women in our community, have an even more difficult time affording the high out-of-pocket costs due to systemic and individual discrimination that means they make less money than the general public, experience discrimination in employment and housing, and lack safety in public. We are particularly pleased by today’s decision because of the inclusion of procedures such as facial feminization surgery and breast/chest surgeries, to name a few which were previously considered cosmetic and excluded from insurance coverage. We advocated for the EHB-benchmark plan because we knew the improvements to the health and wellness for transgender Coloradans would be immense, and saw in the research that including gender-affirming care would not have significant impacts on insurance rates for Coloradans.”

This approval, in alignment with the Biden-Harris administration’s vision to expand transgender health access, builds upon the foundation of access that the 2014 Affordable Care Act (ACA) created for the LGBTQ+ community. Also know as “Obamacare,” the ACA extended health insurance coverage to more than 600,000 Coloradans through the public health exchange and Medicaid expansion, eliminated pre-existing conditions and transgender-specific exclusions, established cost parity, clarified that spousal benefits must apply to same sex couples, and removed limits on annual and lifetime spending for people with chronic conditions. 

Taking effect in 2023, Colorado’s new EHB-benchmark plan advances and expands access for transgender and nonbinary Coloradans. By including gender-affirming care, this plan will help save lives, alleviate disparities and inequities for transgender and nonbinary Coloradans in society, employment and healthcare.

LGBTQ Coloradans shopping for health insurance plans this year through Connect for Health Colorado can access our forthcoming 2022 Insurance Buyers Guides in November to better understand what is covered.