Minnesota legislation drops medicaid for gender reassigment

[Betsy]

The following is an email exchange I had today:

The original email:
Dear Betsy,

A group of us have been campaigning to get MN to drop coverage of circumcision from Medicaid. Since I am licensed to practice law there, I used that, and my mini-pulpit at <removed> as leverage. Last week the governor signed a new budget that drops circumcision unlesss medically necessary or for religious reasons.
(The latter is clearly unconstitutional, but that challenge can come much later when someone has the chutzpah to charge their whole bris to the state.)

I noted with some surprise and thought of you instantly when I saw that gender reassignment surgery has ALSO been delisted. I need not preach to the choir, but that is a wonderful victory for both of us. Is that BLO at work or ISNA or whom?

I am embarrassed to say I would have assisted in that effort had I known it was in play.

Nevermind--a terrific result for us both. How many states have defunded gender reassignment surgery? How many never covered it? How many still do?
Cheers!

And the legislation as it was sent to me:

*Take a look at the language of the bill the governor signed (though I have this third hand and need to verify this.



> 43.29 Sec. 23. Minnesota Statutes 2004, section 256B.0625, is

> 43.30 amended by adding a subdivision to read:

> 43.31 Subd. 1a. [SERVICES PROVIDED IN A HOSPITAL EMERGENCY

> 43.32 ROOM.] Medical assistance does not cover visits to a hospital

> 43.33 emergency room that are not for emergency and emergency

> 43.34 poststabilization care or urgent care, and does not pay for any

> 43.35 services provided in a hospital emergency room that are not for

> 43.36 emergency and emergency poststabilization care or urgent care.

> 44.1 Sec. 24. Minnesota Statutes 2004, section 256B.0625,

> 44.2 subdivision 3a, is amended to read:

> 44.3 Subd. 3a. [GENDER SEX REASSIGNMENT SURGERY.] Gender Sex

> 44.4 reassignment surgery and other gender reassignment medical

> 44.5 procedures including drug therapy for gender reassignment

> are is

> 44.6 not covered unless the individual began receiving gender

> 44.7 reassignment services prior to July 1, 1998.

> 44.8 Sec. 25. Minnesota Statutes 2004, section 256B.0625, is

> 44.9 amended by adding a subdivision to read:

> 44.10 Subd. 3c. [CIRCUMCISION FOR NEWBORNS.] Newborn

> 44.11 circumcision is not covered, unless the procedure is medically

> 44.12 necessary or required because of a well-established religious

> 44.13 practice.

> 44.14 [EFFECTIVE DATE.] This section is effective July 1, 2005,

> 44.15 and applies to services provided on or after that date.

My reply to a listserv about it:
Someone sent me a copy of the Minnesota legislation that denies
Medicaid coverage for newborn circ. The legislation unfortunately
went a step further by denying medicaid coverage for sex
reassignment surgeries. The note I received felt this was a good
thing in our efforts to end unnecessary intersex genital mutilation.

That is not the case and this part of the legislation is troublesome
for me and likely other intersex activists. It's precisely the
reason we have chosen to go the route of education and not laws
because legislation does not consider all situations.

The worse thing is it doesn't affect intersex surgeries on infants
at all as few of them are considered reassignment surgeries. Most
would be considered 'assignment' in nature and the medical
profession often calls them "reconstructive" even though that
implies something is being put back when in reality, it is the
removal of tissue.

Transsexuals are the ones who will be most affected by it and yes,
some transsexuals are intersex. If someone managed to escape
surgery as a child but choses on their own to get it, they will now
be denied medicaid for it. Even if there is no intersex status
involved, this is very troublesome for some of our key allies.

This is a huge problem for us as well and it is something we
recognize as also a problem with insurance companies. When people
escape infant surgery and decide after childhood health insurance
runs out, it is usually considered transsexual surgery, even if the
person is not transitioning gender with it. For instance, a woman
born without a vagina and decides after age 18 or so to have a
vagina built, she can now be denied medicaid for it as it will
likely be considered reassignment surgery. We've encountered
several situations where this has occurred and women being told they
must satisfy the harry benjamin standards before undergoing the
procedure. This will add another unnecessary hurdle for her because
legally, it is considered cosmetic reassignment surgery.

Other situations where this legislation could be a problem is if the
person has partial androgen insensitivity and id's as female.
Around puberty, she would want her gonads removed, otherwise she
will suffer unwanted masculinizing side effects and this legislation
could deny her medicaid coverage for a cosmetic procedure she needs
(but is considered cosmetic) The person who had "reconstructive"
gender assigning surgery as an infant and decides later on the wrong
choice was made can now be denied medicaid coverage to correct it.

The consequences of short-sighted legislation can be horrible and I
would plead with anyone considering similar efforts to think out the
ramifications before pursuing it.

Betsy Driver
Bodies Like Ours