July 30, 2016
By Angelica Walker

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A transgender flag was raised at city hall during last year’s Philadelphia Trans Health Conference; photo via newsworks.org

Last week, Pennsylvania became the twelfth state to explicitly cover gender transition-related care in their Medicaid program. This exciting policy change marks a huge step in protecting transgender Pennsylvanians across the state. After Governor Tom Wolf signed an executive action announcing the new coverage, his office released a statement criticizing North Carolina’s anti-trans bathroom laws and declared, “the governor wants to make clear that Pennsylvania is inclusive, welcoming, and open for business for everyone.”

The new policy brings the state up to par with a new nationwide rule that prevents state Medicaid programs from denying transgender patients medically necessary transition services. The rule also prevents state programs from requiring intrusive and unnecessary examinations or “conversion therapy;” harassing, coercing, or intimidating patients into giving up their rights; refusing to provide medically necessary counseling or referrals; and refusing to provide patients with bathrooms that match their gender identity.

Up until now, it’s been incredibly hard for low-income transgender Americans to access transition services. Without insurance, hormone therapy can cost patients over $1,200/year, for life. Sex reassignment surgery can easily cost over $30,000. After adding in breast augmentation and related surgeries, the total can reach well over $60,000. This is an awful lot, considering transgender Americans are four times more likely than average to be living in poverty.

Without these treatments, transgender folks face a high risk of discrimination, harassment, violence, and even death. According to a Galop report, 3 in 4 transgender people will be the target of a hate crime every year. At least 22 American transgender men and women – 19 of them women of color – were killed in 2015, making it the most lethal year on record for gender-nonconforming people. Surgeries help transgender people “pass” as cisgender, which is (sadly) often necessary to prevent discrimination and violence.

Being unable to access transition services also takes a huge toll on mental health. Approximately 40% of transgender Americans attempt suicide at some point in their life, compared to less than 5% of the general public. However, according to a study by the University of Connecticut, transgender people with access to surgery that allows them to “pass” report quality of life just as high as cisgender people; in other words, when transgender people are treated the same as cisgender people, the risk of suicide becomes no different than for anyone else.

This is why transition services are medically necessary; they are literally a matter of life and death. Choosing not to cover them is choosing death.

Of course, there’s still a ton of work left to be done. The fight is not over. Accessing Medicaid is still a long, challenging process, and there are still many unanswered questions about hard it will be in practice for people to get their care deemed “medically necessary”. But, at the very least, our state government sending a strong message to transphobic people across the state: transgender lives matter.



Angelica Walker is an intern for The New People covering LGBTQ rights and criminal justice reform. She is a junior at the University of Pittsburgh studying social work, legal studies, writing, and political science.