Proposed Medicaid changes eliminate age requirement for gender-affirming surgery

BURLINGTON, Vt. (WCAX) New changes are being proposed that would open up opportunities for transgender people to get gender-affirming surgery, a variety of procedures that can help match a person's sex characteristics with their gender identity.

Not everyone who identifies as transgender wants to have gender-affirming surgery, but for those who do, it can be life changing.

"Young adults starting jobs, graduating from high school -- many are going to college and it's very important that they present in a way that conforms to their gender identity for their own mental health, feelings of confidence and also safety," said Dr. Rachel Inker with the Transgender Health Clinic at the Community Health Centers of Burlington.

CHCB was one of several organizations working with the state of Vermont to change Medicaid guidelines for gender-affirming surgery. Right now, if you're under Vermont Medicaid, you must be 21 or older to receive the procedure but state regulators are proposing that requirement be eliminated.

"That age of 21 seems arbitrary when the professional guidelines really recommend age 18 or older," said Inker.

Inker says the decision to have surgery is not one made quickly and is often lengthy and there are younger teens who have the surgery, but it's a different process.

"It's really bringing Medicaid up to speed with what the other major insurance companies in the state of Vermont are offering already," said Taylor Small with the Pride Center of Vermont.

The Pride Center helped advocate for additional Medicaid changes including getting rid of hormone therapy as a prerequisite for a mastectomy, lowering the minimum hormone therapy requirement for genital surgery from two years to one and eliminating "sufficient breast development" for breast augmentation mammoplasty. These changes are all professional guidelines from the World Professional Association for Transgender Health Standards of Care.

Small says some of the requirements were invasive, especially for breast surgery.

"They asked for photo submissions from trans women of their chests so that there was a group of folks who would determine whether or not breast augmentation was legitimate for that person," said Small.

A study by the American Academy of Pediatrics found more than half of trans male teens attempted suicide, while nearly 30 percent of transgender women did. Inker says the age change, specifically, can make a huge difference.

"They're often an unsupported and marginalized group of kids," she said. "They're super resilient, often gutsy but often struggling so this change will be of great benefit to them."

There is a public comment hearing until July 17. After that, the Agency of Human Services will file a final proposed rule with the Office of the Secretary of State and the Legislative Committee on Administrative Rules. There will then be a hearing and then a vote from the Legislative Committee on Administrative Rules on the final proposed rule. After the committee has voted, AHS will file the adopted rule with the Secretary of State and LCAR. It will become effective at 15 days after filing.