Hair removal in gender-affirming care not covered by most Medicaid, ACA policies
Medicaid and Affordable Care Act policies often do not cover permanent hair removal treatments for transgender patients, which could pose a barrier for gender-affirming care, according to a study published in JAMA Dermatology.
“Hair removal can be a vital component of the gender affirmation process for many transgender and gender minority individuals, as hormone therapy often does not adequately remove facial and body hair,” Nick Thoreson, BS, Boston University School of Medicine medical student and research student in the department of dermatology at Beth Israel Deaconess Medical Center, told Healio. “We wanted to examine the degree to which policies both public and private cover this aspect of gender affirmation care.”
In a cross-sectional study performed in September and October 2019 with a follow-up in January 2020, 174 Medicaid and ACA policies were examined for hair removal coverage.
Among 123 ACA policies, 4.9% excluded gender-affirming care, 7.3% were silent on gender-affirming care, 7.3% made no mention of gender-affirming care, 42.3% excluded hair removal coverage and 38.2% had some form of hair removal coverage. Of the ACA policies covering hair removal, 85.1% only permitted coverage preoperatively for gender-affirming surgery and 14.9% provided coverage without any explicit restrictions.
Among 51 Medicaid policies, 19.6% excluded gender-affirming care, 37.3% were silent on gender-affirming care, 5.9% prohibited hair removal coverage, 25.5% made no mention of hair removal coverage, 9.8% included coverage in the context of genital surgery and 2% covered hair removal outside of genital surgery.
Statistical analysis showed when comparing private ACA policies with state Medicaid policies, private plans had higher odds of hair removal coverage with 38.2% of private policies offering some form of hair coverage vs. 11.8% of Medicaid policies offering some form of hair coverage (OR = 4.6; 95% CI, 1.8-11.7; P = .001). Overall, most health care policies either excluded hair removal coverage entirely or only provided coverage for hair removal preoperatively.
“This pinpoints a major lapse in coverage for many insurance policies, which may cover other aspects of transgender care,” Thoreson said. “Clinicians should continue to act as advocates for their patients and work with key stakeholders to develop formal guidelines for coverage of permanent hair removal for patients undergoing gender affirmation.” – by Kate Burba
Disclosures: The authors report no relevant financial disclosures.