[P]roposed updates to Vermont’s Health Care Administrative Rules (HCAR) will allow transgender youth under age 21 to undergo gender-affirming surgery, a shift that advocates say more completely aligns with medical best practices.
HCAR, which is overseen by the Agency of Human Services, regulates the administration of Medicaid in Vermont. Its jurisdiction includes eligibility, provider responsibilities, and reimbursement. But it also determines who can receive gender-affirming surgeries under state insurance — and the newly proposed rule would broaden Medicaid’s coverage, allowing more Vermonters to access certain procedures.
“The proposed new rule is intended to standardize and update current clinical criteria, including outlining the conditions for coverage, listing the Medicaid-covered genital and breast surgeries, and expanding coverage in four ways in order to address barriers to accessing Gender Affirmation Surgery,” Nissa James, the director of communications for the Department of Vermont Health Access, wrote in an email.
In addition to allowing youth under 21 to receive gender-affirming surgery, the proposal eliminates hormone therapy as a prerequisite for mastectomies, lowers the minimum hormone therapy requirement for genital surgeries, and eliminates “sufficient breast development” as a criterion for breast augmentation mammoplasty.
Dana Kaplan, the executive director of LGBTQ youth advocacy group Outright Vermont, said that the rule is a significant step towards letting people “be who they are.”
“Being trans, in and of itself, is not the issue,” he said. “The issue is being trans in a state, in a culture, in a nation that doesn’t provide the same accommodation and access that other folks get.”
Kaplan and Rachel Inker, a doctor with Community Health Centers of Burlington, both framed the new rule as an issue of safety. Kaplan called it “a form suicide prevention.” Inker discussed the importance of “passing,” or being read as the gender that one identifies as; transgender or gender-nonconforming people are at an elevated risk of violence, she said, one that surgery may help mitigate.
“It’s important for people to think about how trans people are targeted, particularly when they’re identified as not passing,” Inker said. “There’s a safety piece to this decision that might be under-appreciated.”
According to Inker, the rule may also counterbalance the advantages that youth who can afford private insurance or out-of-pocket surgery currently possess. Updated Medicaid coverage could be especially significant to rural Vermonters, she noted, or to those from low income backgrounds.
Both Outright Vermont and the Community Health Centers of Burlington — the organizations that Kaplan and Inker are a part of, respectively — participated in drafting and providing feedback on the rule. According to Inker, the process began last fall, and several additional groups took part.
The rule was submitted on May 22 and it is open for public comment until July 17. After the comment period ends and the comments are taken into account, the Legislative Committee on Administrative Affairs will hold a hearing and a vote before the final rule goes into effect.
If the rule is passed, Kaplain said that it will be a “clear win” for those in need of coverage for gender-affirming surgery.
“Some of this comes down to trusting and believing that trans people know what they need to move through the world,” he said. “Providing this type of access at an earlier age is really good prevention, that then allows kids to just be kids.”
And earlier version of this story referred incorrectly to the agency that will hold a hearing on the proposed rule. It is the Legislative Committee on Administrative Affairs.