For Consumers

Washington, feds take action to solidify insurance protections for transgender people

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May 12, 2021

OLYMPIA, Wash. – Gov. Jay Inslee signed a bill (2SSB 5313) today prohibiting health insurers from discriminating against policyholders by denying medically necessary treatment, regardless of their gender expression or identity. The new law improves on the protections already in place in Washington state and focuses on the specific barriers to gender-affirming care that patients were encountering, including blanket exclusions for certain services. 

“Our state laws are even more clear now that patients, regardless of their gender expression or identity, cannot be discriminated against,” said Insurance Commissioner Mike Kreidler. “Despite our existing laws, many insurers denied coverage for certain services and forced policyholders to file multiple time-consuming appeals. This is simply wrong. The new protections in this bill will ensure once and for all that people get the medically necessary coverage they deserve.”

The bill was sponsored by Sen. Marko Liias, D-Lynnwood.

The new law clarifies the services that must be covered and focuses on removing specific barriers patients faced. Individual and small group health insurance plans issued on or after Jan. 1, 2022:

  • Cannot deny or limit coverage for gender-affirming treatment when it is medically necessary and prescribed by a medical professional.
  • Cannot apply categorical cosmetic or blanket exclusions to gender-affirming treatment.

Services that insurers previously used blanket exclusions to deny coverage include: facial feminization, tracheal shaves, hair electrolysis, mastectomies, breast reductions, breast implants or any combination of gender-affirming procedures, including revisions to prior treatment. 

The law also applies to plans administered by the Health Care Authority, including Medicaid/Apple Health plans. 

The Office of the Insurance Commissioner, the Health Care Authority and the Department of Health must deliver a report to the Legislature on Dec. 1, 2022, outlining geographic access to gender-affirming treatment across the state.

Washington state passed legislation in 2019 protecting policyholders from discrimination based on race, color, national origin, disability, age, sex, gender identity or sexual orientation. 

Additionally, the Affordable Care Act (ACA) and associated regulations protect transgender people from discrimination by their health insurer and from blanket denials of gender-affirming services. 

President Biden on May 10 announced his administration will enforce federal protections, reversing the weakening of safeguards by the previous president. The Trump administration’s attempts to reverse transgender people’s rights were blocked by federal courts in New York and Washington, D.C., in 2020.  

Learn more about transgender health insurance rights: