Trans Health Equity Act to provide care for low-income Marylanders in 2024

Dec. 30—By Hannah Gaskill — hgaskill@baltsun.com

December 30, 2023 at 5:00 a.m.

Beginning Jan. 1, low-income, transgender adults in Maryland will have their gender-affirming care covered by the state's Medicaid system.

For the state's LGBTQ+ community, this is a reason to celebrate — "especially at a time when, across the country, we've seen this concerted effort to attack trans rights and many other rights," Sam Williamson, one of the founders of the Trans Rights Advocacy Coalition, told The Baltimore Sun.

Williamson is a staff attorney for Disability Rights Maryland and uses they/them pronouns. While acknowledging there is more to be done to secure civil rights for Maryland's LGBTQ+ community, they said during a phone interview in late December that "it's really great to know that in a few days, trans people using Medicaid in Maryland" will be able to access the care they need to survive and thrive.

The Maryland Medical Assistance Program will be prohibited from denying gender-affirming treatment based on an adult patient's gender identity or excluding certain treatments on the basis that they are cosmetic.

Run by the state, the Maryland Medical Assistance Program pays for health care services for low-income residents with state and federal funds.

Under the Trans Health Equity Act, Maryland's Medicaid system will be required to cover all gender-affirming treatment, or treatment that is medically necessary health care prescribed by a medical professional to treat conditions related to their patient's gender identity, to adults. This includes hormone therapy; puberty blockers; hair alteration; voice therapy; surgical alterations to an individual's face, neck, chest, abdomen, genitals and buttocks; and fertility preservation procedures, among other treatments that align their body or physical appearance with their gender identity or alleviate distress caused by gender dysphoria.

According to the Movement Advancement Project, a nonprofit think tank aimed at promoting inclusive policies, Maryland is now one of 26 states that requires their Medicaid programs to cover gender-affirming health care. Washington, D.C., and Puerto Rico have also banned insurance discrimination based on a person's gender identity.

Beyond providing residents with necessary medical treatment, the Trans Health Equity Act can also lead to positive mental health outcomes in the LGBTQ+ community.

In an email to The Baltimore Sun, Behavioral Health Systems Baltimore pointed to a 2020 study that demonstrated that nine of 10 transgender adults who did not have access to gender-affirming care as an adolescent but wanted to receive it have experienced suicidal ideation.

"Implementation of the Trans Health Equity Act will help reduce discrimination and provide long overdue health care [for] so many in our community," Adrienne Breidenstine, the vice president of policy and communications at Behavioral Health Systems Baltimore, said.

Kevin Lindamood, the president and CEO of Health Care for the Homeless, an organization that connects unhoused people with necessary care services, called the impending full implementation of the Trans Health Equity Act "transformative and lifesaving."

According to Lindamood, people who are Medicaid-eligible are "already at increased risk of homelessness."

"On the streets or in unstable transient arrangements, transgender people face greater exposure to violence, illness and premature death. Access to gender-affirming treatment is a necessary step toward stability and to prevent and end homelessness," he said in a statement. "We applaud the nonbinary and transgender community — and particularly the Trans Rights Advocacy Coalition (TRAC) — who led a multiyear advocacy campaign, often at great personal sacrifice; the legislative leaders who championed the bill's passage; and the governor who, recognizing the humanity of all Marylanders, signed it into law."

Democratic Gov. Wes Moore stood in support of the Trans Health Equity Act, pledging prior to the end of the 2023 legislative session that he would sign it into law.

The governor has continued to advocate for trans rights in and outside of Maryland.

At a Pride Month reception at the governor's mansion this summer, Moore issued an executive order to protect gender-affirming health care in Maryland and those who seek it from facing legal repercussions in other states — effectively turning Maryland into a safe haven for the transgender community.

Williamson said that there will be a push to codify Moore's executive order during the 2024 legislative session, which begins Jan. 10. They said this bill will largely mimic a bill passed in 2023 that prohibits state officials from assisting other states' criminal investigations of and court proceedings against patients and providers involved in abortion care.

In an interview in early December, Lee Blinder, the founding executive director of Trans Maryland, recalled spending this year's Transgender Day of Visibility in Annapolis with Moore, Lt. Gov. Aruna Miller and Secretary of State Susan C. Lee, who listened to transgender people talk about their lived experience and their policy ideas.

Blinder was also the first trans person to work on a gubernatorial transition team in Maryland. They served on Moore's Committee for Unlocking Opportunity, which, among other things, helped the Moore-Miller administration strategize how to best support historically marginalized groups.

Blinder, who also uses they/them pronouns, has been working in Annapolis with other trans and LGBTQ+ organizers for several years. Their first legislative win was the passage of a 2019 bill requiring the Motor Vehicle Administration to allow applicants for driver's licenses, state-issued identification cards or permits to operate a moped to select "X" as a gender option rather than "M" for male or "F" for female.

This was the second time that the bill, which passed largely along party lines, worked its way through the legislature. It was enacted without former Republican Gov. Larry Hogan's signature.

Though the law passed, the rollout was slow, and, according to Blinder, tended to happen one agency at a time.

Blinder said that it took multiple attempts to apply to the state's Commission on LGBTQ Affairs, which they currently serve on, because they didn't have the option to choose the "X" marker for their gender on the application. They have also worked with the Maryland State Board of Elections to make sure voters can accurately identify themselves at the polls.

According to Blinder, Moore made all of the difference in the passage of the Trans Health Equity Act and signing it into law.

During 2020's legislative session, which was truncated by the onset of the coronavirus pandemic, the legislature passed a bill prohibiting medical professionals and facilities from discriminating against patients for their immutable traits, or their race, color, religion, sex, age, national origin, marital status, sexual orientation, gender identity, or disability status.

That bill was enacted without Hogan's signature.

Gender identity was not a protected class in Maryland until the legislature adjusted the definition in 2021 — the same year that a law was passed that removed the discovery of a person's immutable traits, like gender identity and sexual orientation, as a viable course of defense for assault and murder. Hogan did not sign either bill.

In 2022, the legislature created a process for people to change their name on their marriage licenses and established that public schools and private schools that receive state funding cannot discriminate against students or their families for being a member of a protected class. These, also, were enacted without the Hogan's signature.

Though Maryland is replete with progressive politicians, Blinder said that, oftentimes, there are politicos who don't know about gender beyond the binary.

Most people learn about gender early on in their lives from their parents or teachers, so to teach adults about a third category of person, which could make them uncomfortable because it's a foreign concept — or it makes them face their relationship to their own gender — can be difficult, particularly during a bill hearing.

Sporting glitter-covered Converse emblazoned with the colors of the trans flag, Blinder said they and their colleagues in their work have stood in committee rooms full of adults confused at the idea of living a life beyond being a boy or a girl.

Someone has to teach them.

Sometimes, Blinder said with a laugh, "it's me."

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