Wills, Trusts & Estates Prof Blog

Editor: Gerry W. Beyer
Texas Tech Univ. School of Law

Sunday, January 13, 2013

Oregon and California Have Insurance Policies More Friendly to Transgender Patients

Unknown-1 UnknownMany health insurance policies broadly exclude coverage of transgender patients or classify it as a pre-existing condition. Two states are making moves to change this.

Regulators in Oregon and California have directed some health insurance companies to stop denying coverage for transgender patients.  They told some private insurance companies that they must pay for a transgender person's hormone therapy, breast reduction, cancer screening, or any other medically necessary procedure if they cover it for patients who aren't transgender.  Transgender advocates say that gender reassignment, through hormone treatment or surgery, is medically necessary, but insurance companies tend to argue that these procedures are cosmetic.

The changes apply to companies insuring about 1/3 of Oregonians and about 7% of Californians.  Advocancy groups see the action as a major step forward in achieving better health care coverage for transgender Americans.  

Officials in both states clarified that the new regulations aren't new policies but just a classification of anti-discrimination laws passed in California in 2005 and in Oregon in 2007.  State regulators doen't have authority to force insurance companies to cover specific procedures.  But they have told insurers that if they provide breast reconstruction for patients with back pain, they can't deny it for a gender reassignment that is determined medically necessary.

See Jonathan J. Cooper, Transgender Health Coverage: California and Oregon Direct Insurance Companies to Provide It, HuffPost, Jan. 13, 2013.  

Special thanks to Brian Cohan (Attorney at Law, Law Offices of Brian J. Cohan, P.C.) for bringing this article to my attention.


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