Any word on WA state and GRS medicaid?

[Hermosa_Tabby]

I am having an extremely hard time finding information on this.

I met someone who stated they had gotten approved to get surgery under medicaid and were just waiting to get in to the surgeon, but when I try to find information and maybe a success story, the internet is blank. The person I spoke to I have lost contact with, so following up with them is out of the question.

Searching for information in WA in general is a pain as Google likes to include DC even when you put WA state.

I get lots of articles from 2009. Nothing recent.

[Mariah]

I'm familiar with one working with medicare when associated with another insurance with it, but not medicaid off hand. I didn't even learn of that tell the other day. I'm not familiar with any other cases except private insurance in Washington State. What I can tell you though is you will need a referral most likely to get the insurance to cover it. So the key is to find which excepts medicaid from Washington State which I believe is often refereed to as Washington Apple Health. You also may want to try searching the following locations.
https://fortress.wa.gov/hca/p1findaprovider/
https://www.dshs.wa.gov/
and on the second link use the search box and type GRS or some variant on that in the search box and see what comes up. The other thing is try searching it on google but use Washington Apple Health instead of medicaid. You might have better luck. Also calling the different surgeons offices and asking directly and or calling or going into your local CSO office unless your a long term care client in which case call your local HCS office. Good Luck and Hugs
Mariah
Mariah.

[Tysilio]

At present, only six states (CA, MA, VT, DC, NY, and OR) provide Medicaid coverage for GRS, although some others do cover HRT.

Here's a fairly recent update on insurance coverage in Washington state. The state insurance commissioner issued a ruling last year to the effect that private insurance companies must cover transition-related health care when it involves procedures which are covered for other medical conditions. This means that HRT and mastectomy, for example, must be covered, but an insurer which doesn't cover breast implants in general would not have to cover them for transgender patients. Transgender health care, including GRS, is also now covered under the WA public employees' policy. Unfortunately, these rulings don't apply to Medicaid, which is run by a different agency.

However, changes are starting to happen at the federal level: according to Lambda Legal, this fall the Dept. of Health and Human Services will be issuing "proposed rules under section 1557 of the ACA. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability for any health program receiving federal assistance, and HHS has stated further that section 1557's sex discrimination prohibition extends to gender identity or failure to conform to conventional notions of masculinity or femininity."

If these rules take effect, it's hard to see how they won't apply to state-run Medicaid programs --  although I'm sure there'll be lots of foot-dragging.