Health coverage for gender-affirming care on Legislature’s agenda

CARSON CITY — Health insurance providers may soon be required to cover treatments for gender-affirming care under a bill heard by Nevada lawmakers Wednesday morning.

Senate Bill 163, which was presented by Sen. Melanie Scheible, D-Las Vegas, would require both public and private health insurance plans, including Medicaid, to cover the treatment of conditions related to gender dysphoria and gender incongruence or risk losing their state certification.

“It is important for insurance providers to cover medically necessary treatments for these conditions because they can have a significant impact on a person’s health, including their mental health, and their quality of life,” said Scheible, one of the bill’s primary sponsors.

Gender dysphoria is a psychological condition suffered by transgender people whose gender identity conflicts with the sex they were assigned at birth, according to the American Psychiatric Association.

An amendment to the bill, filed by Scheible, bars insurers from discrimination on the basis of “actual gender identity or perceived gender identity.” The amendment also blocks those insurers from refusing gender-affirming care that’s determined to be medically necessary.

List of treatments

Under the amendment, care determined to be medically necessary under the World Professional Association for Transgender Health Standards of Care must be evaluated by an insurer for coverage. Under the most recent version of their standards of care, hysterectomy, vaginoplasty, body hair removal, gender-affirming facial surgery and gender-affirming hormones are all included in the list of medically necessary gender-affirming treatments.

Scheible emphasized that the bill does not change laws around parental consent, and treatments under the bill would still require minors to have their parents’ permission.

The senator said the bill would solidify requirements for health insurance providers to cover this type of care, which are currently mandated under a patchwork of federal regulations, federal law and court decisions.

Lifesaving care

Several trans activists and groups spoke in support of the bill, many of whom said gender-affirming care can be lifesaving.

“For many transgender individuals, the biggest barrier in receiving gender-affirming care is a lack of insurance coverage. And for many transgender folks, this is lifesaving care,” said Ryan Vortisch, an intern with the American Civil Liberties Union of Nevada.

The Nevada chapter of the National Alliance on Mental Illness, the Nevada chapter of the American Academy of Pediatrics, the Nevada State Medical Association and Planned Parenthood, among others, testified in support of the bill.

But lawmakers heard from a handful of groups and several individuals in opposition to the bill, including representatives from the Nevada chapter of the Independent American Party, the Nevada Republican Party, the Libertarian Party of Nevada and Americans for Prosperity. Some opponents to the bill raised concerns about the cost to taxpayers for providing such care through the state Medicaid program.

“We disagree that it should be taxpayers that should be burdened with this responsibility,” said Wiselet Rouzard, a representative with Americans for Prosperity.

“This bill opens up Pandora’s box for many, many other more cosmetic medical procedures in which the taxpayer shouldn’t be burdened with so we urge you to vote no on this bill.”

But Schieble said the bill would actually save the state money.

“Different agencies within the state of Nevada have already been taken to court, forced to pay for these procedures and additional damages and attorneys’ fees,” she said. “This is actually a cost saving measure for the taxpayers of Nevada.”

In Carson City, more than 30 people attended the approximately 2½-hour hearing.

A similar bill sponsored by Scheible, Senate Bill 139, was introduced during the 2021 legislative session but died in the Senate Finance Committee.

The Senate Commerce and Labor Committee will take up the bill at a future meeting for a vote; if approved, it would go to the Senate floor for consideration.

Contact Taylor R. Avery at TAvery@reviewjournal.com. Follow @travery98 on Twitter.