A coalition of mental health providers who treat transgender people in Connecticut have been complaining for months that the state Department of Human Services imposed what they call unnecessary and overly restrictive requirements on patients seeking transgender surgery. gender affirmation.
The changes affect low-income state HUSKY health insurance patients. Before covering genital surgery to treat gender dysphoria – the psychological distress that can result from an incongruity between their sex assigned at birth and their gender identity – the DSS now requires proof that the person has lived for at least a year in the new genre and came to family and friends. DSS accepts a legal name change as proof.
In March, the DSS imposed a blanket denial of gender-affirming surgery for anyone under the age of 18 and began requiring two letters from mental health professionals assessing transgender patients before certain surgeries would be covered. Alexandra Solomon, a clinical social worker with a therapy practice in Glastonbury and said one of the leaders of the coalition. The DSS previously required a letter.
The DSS also stipulated that one of the providers must have a doctorate. Due to a shortage of these providers, Solomon said it was nearly impossible for HUSKY patients to comply. The DSS has since dropped this requirement, but has begun requiring a letter from the prescriber stating that any mental health or substance abuse condition a patient must be stable before surgery is covered.
The new requirements outraged about 60 providers who wrote to DSS in June saying the changes violated state law.
“It’s so difficult for our patients to access gender-affirming surgeries to begin with, but the way the DSS has changed policies has made it even more difficult,” said Dr. AJ Eckert, member of the coalition and medical director of Anchor Health’s Gender & Life-Affirming Medicine Program in Hamden, said. “It’s like they’re trying even harder to keep these surgeries.”
In August, the DSS dropped the requirement for a doctorate and now only requires one letter from providers for thoracic surgeries and facial feminization procedures. It also removed the word “irreversible” from the description of the surgeries.
Solomon said the DSS’s use of “irreversible” and terms such as “transsexual” or “opposite gender” sound a lot like the political “dog whistle language” used by anti-trans hate groups.
DSS chief medical officer Dr Brad Richards wrote to Solomon in July that the changes were made because many mental health assessment letters were templates with only names changed. He added that the DSS had encountered many requests for gender-affirming surgery from patients with “significant, untreated or undertreated mental health issues”.
DSS released a statement from Richards this week that read, “DSS and its administrative service organizations have coverage policy update procedures that we use to keep our policies evidence-based and current.”
“We recognize the unique needs of the LGBTQ+ community and aim to provide coverage that allows individuals to work safely and effectively with their healthcare providers to determine when and if gender affirmation surgery is right for them” , said Richards.
The coalition is calling on the DSS to form a policy advisory group that includes transgender providers. About half of the 15 providers who have been most active in the coalition are transgender, non-binary or other than cisgender, said Solomon, who identifies as genderqueer and non-binary.
Coalition members say the DSS has declined to meet with mental health providers and will only meet with Eckert, who identifies as non-binary and transgender, because he is a doctor. Eckert, who has another meeting with the DSS on Tuesday, called it “symbolic.”
“They put me in a position where I had to play the angry trans person,” Eckert said.
Richards’ statement said the DSS is considering further changes to match recent updates to widely accepted guidelines from the World Professional Association for Transgender Health.
Eckert said that would be good news since WPATH now recommends that transgender people live for six months in a new gender, instead of a year, before surgery is covered.
Coalition member Ms Reim Ifrach, a non-binary transgender art therapist who counsels transgender clients and people with eating disorders at Rainbow Recovery in Hamden, said gender-affirming surgery can save lives lives because transgender people are more likely to attempt suicide than other groups in the United States
Unlike many HUSKY patients, Ifrach said they were lucky to have a supportive partner, stable income and private health insurance to pay for gender-affirming surgery in 2021. They said the surgery breast surgery and hysterectomy had changed their lives.
“It was such a breath of fresh air,” Ifrach said. “I felt like my body belonged to me.”
This story was originally published on December 9, 2022 by the Connecticut Health Investigation Team.