Illinois Medicaid to cover gender affirming surgery

(Photo by Zackary Drucker as part of Broadly’s Gender Spectrum Collection)

SPRINGFIELD — The Illinois Department of Healthcare and Family Services (HFS) announced Friday that the state’s Medicaid program would cover gender affirming surgeries for members under new policies being established.

“Healthcare is a right, not a privilege, and I’m committed to ensuring our LGBTQ community and all Illinoisans have access to that right,” Illinois Gov. J.B. Pritzker said in a statement. “Expanding Medicaid to cover gender affirming surgeries is cost effective, helps avoid long term health consequences, and most importantly is the right thing to do. With continued attacks coming from Washington, this administration will always stand with our transgender community and their right to lead safe and healthy lives.”

Under the proposed coverage rules, Medicaid members age 21 and older who are diagnosed with gender dysphoria will now be eligible for genital and breast-related surgeries.

Illinois already covered hormone therapy. According to today’s announcement, the most recent data available shows that 1,400 of the state’s 3.1 million Medicaid members are diagnosed with gender dysphoria. Last year, around 2,500 prescriptions for hormone therapy were covered.

The U.S. Department of Health and Human Services in 2016 set rules to require access to gender transition services. The new policy will include Medicaid members in HealthChoice Illinois, the state’s managed care program, as well as those receiving their care through traditional fee-for-service.

“Today, Illinois took another critical step toward treating transgender people with dignity and respect by recognizing that their health care needs must be affirmed and fulfilled,” said John Peller, president/CEO of the AIDS Foundation of Chicago, in a statement. “Low-income trans Illinoisans — some of the most vulnerable people in the state — will finally be able to get the medically-necessary health care services that are their right.

“Howard Brown Health is very pleased to see that the new Governor and his administration – within the first three months of being sworn in – have taken an important step in making Illinois a state that guarantees access to healthcare for all of its residents,” said Howard Brown Communications Manger Aisha N. Davis in a blog post. “Under previous administrations, Illinois became one of only ten states that maintained an exclusion for transition-related surgeries in the state’s Medicaid program – making us unlikely bedfellows with Alaska, Georgia, Maine, Missouri, Nebraska, Ohio, Tennessee, Wisconsin, and Wyoming.”

The new policy still needs to be finalized after a comment period.



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