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Colorado first state to require some insurance plans to cover gender-affirming care

COLORADO SPRINGS, Colo. (KRDO) -- Tuesday, Colorado become the first state to require some health insurance plans to cover gender-affirming care.

Beginning in 2023, more gender-affirming care and behavioral and mental health care would be covered as essential health benefits (EHBS), as part of individual and small-group health insurance plans in Colorado.

The requirement won’t apply to people who get insurance from large employers or government programs such as Medicare.

According to the Centers for Medicare & Medicaid Services, the benefits that will be considered essential include face tightening, breast and chest reduction and construction, facial bone remodeling, eye, and lid modifications, and laser hair removal.

The announcement was welcome news to Ethan Anderson, a transgender boy 15-year-old from Colorado Springs who is just beginning treatment.

"I know that even with just going on testosterone I've had some trouble with insurance, so I'm pretty psyched about that," Anderson told KRDO.

Colorado Governor Jared Polis said the added coverage would cost an additional 64 cents per month for people on individual and small-group market plans. Officials said about 20-25% of Coloradans are on such plans.

"It makes me feel good, it makes me feel like the people in government have me in mind, which is really comforting. It's really nice," Anderson said. "It's important for people to know just how difficult it is when you can't have those things done."

Alissa Smith, a spokesperson for Inside Out Youth Services, an organization that serves the LGBTQ+ youth in El Paso County, believes this is a step in the right direction for the community they work with.

"Everyone has trouble accessing and paying for culturally competent health care for gender needs and part of it is because our society does not view this as essential care," Smith continued. "When in reality it is 100% essential."

According to the U.S. Department of Health and Human Services, this decision aligns with the Biden-Harris Administration's efforts to address health care disparities by removing barriers and expanding access to care for transgender individuals.

“Colorado’s expansion of their essential health benefits to include gender-affirming surgery and other treatments is a model for other states to follow and we invite other states to follow suit,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure.

Currently, all insurance companies must cover some form of gender-affirming care, according to the State. However, coverage varies, and it might exclude certain care services even if a health care provider determines it to be medically necessary.

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Spencer Soicher

Spencer is a reporter for KRDO. Learn more about him here.

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