Maryland House passes bill mandating gender-affirming care under Medicaid

The Maryland House of Delegates on Saturday passed a bill that would expand the state’s Medicaid program to cover gender-affirming procedures for transgender, intersex, non-binary, binary, and all other gender-mixed people.

The Trans Health Equity Act, HB0283, would play an important role in ensuring that low-income transgender Maryland residents on Medicaid have access to hormone therapy, puberty blockers, hair alterations, surgery on the face and other body parts, and several other gender-affirming procedures that require are often covered by private insurance.

According to the Williams Institute at the University of California, Los Angeles, 24,000 Maryland residents are transgender and 6,000 are enrolled in Medicaid. In 2022, 98 transgender residents of Maryland received gender-affirming care through Medicaid.

However, the state’s Medicaid program currently only covers some gender-affirming procedures, including mental health services, hormone replacement therapy, and sex-reassignment surgery for patients 18 and older who meet certain qualifications. Gender-affirming care is now usually covered by private insurance.

The legislation, a similar version to one that failed last year, passed the House of Representatives by a 93-37 vote in the final vote. During committee meetings, several Democrats spoke of their support for the legislation, including delegate Anne Kaiser, who backed the bill.

“We are not represented in this House by anyone from the trans community. So me and my 59 co-sponsors are your vote. We are your representative”, Kaiser called.

She continued, “We recognize that what’s being said nationally about trans people are the same lies that were being told about gays and lesbians 20 years ago and that’s one of the reasons I have the passion and the connection to our trans brothers and sisters, our neighbors, our community.”

House Republicans on Friday proposed an amendment to the bill that would prevent eligible persons under the age of 18 from receiving gender-affirming care — a move that mirrors nationwide attacks on such life-saving healthcare for transgender youth.

“This is not about health. This is about the transition from male to female and female to male in children,” said Delegate Mark Fisher, the Republican who proposed the change, according to the Baltimore Banner, sharing his concern that minors could receive such surgeries B. vaginectomies, mastectomies and penectomies.

But Rep. Bonnie Cullison, a Democrat, stressed that “it’s absolutely about health.” Cullison countered Fisher’s argument by adding that the surgeries he was concerned about would only be performed in extreme circumstances and when medically necessary and indicated for the health of the individual. The bill also states that all gender-affirming medical treatments would only be given after consultation between a parent, the patient and the medical provider.

Fisher’s proposed amendment to bar minors from gender-affirming care failed 90-37, according to the Baltimore Banner. A second Republican-backed amendment aimed at preventing gender-affirming care of minors without the consent of both parents failed in the House of Representatives at 91 -36.

The bill now goes to the Senate and, if passed, will be sent to Governor Wes Moore, who previously expressed support for the bill. The passage of the bill in the House of Representatives comes amid the 426 anti-LGBTQ laws sweeping the nation, from bans on drag shows to restrictions on gender-affirming grooming.