Like many of you I am poor, I started transitioning sometime around 2008/2009 but, due to finances had a lot of trouble going full time and thought I could never afford surgery to that end I spent a few years driving a truck without going home often hurting my relationships to try and get the cash for surgery but, it ended up harder than I thought. So here is what I did for my plan B.
1.Move to Washington, I didn't have a job or anything and me and my friends just packed everything into a van we bought for $600 and made a leap of faith to get here. It can be hard while poor but, within a few months we all had jobs and a decent place to stay.
2. Sign up for Apple Health ASAP. I drug my feet on this step it took me a few months but, it is really easy to do just have your tax returns/pay stubs available for them though they can look up and verify electronically sometimes.
3. Pick your PCP/Health insurer. There is a private company and a public part to Apple Health. The public part called provider one is mostly what pays for surgery, etc but the private company will be the one that pays for doctors visits, hrt, etc. There are many options but I picked Molina Healthcare just because it was easy to look up their trans policies but, you should probably do more research about what who is best for you though I have had no problems with Molina. You will be assigned a close PCP randomly when you start, you have the right to select a new PCP every month so I researched trans friendly doctors, there should be no shortage of these in the Puget Sound, it did increase my commute to the doctor from 5 to 30 minutes however.
4. Schedule an initial PCP visit. I printed out all of my old medical records to ensure she could get a handle on the hormones I have been taking for years and to see my diagnosis's. Make sure you get there way early the first visit tends to have boatloads or paperwork and if you are poor like me you don't have a car so travel times are a bit less certain.
5. Politely ask for a referral to who you want GCS with. I asked for Dr. Stiller since he knows what he is doing doesn't have a long waitlist and is the primary GCS doctor here. I know people who went to Dugi and it was a bit more paperwork, and they will no longer work with Marci Bowers afaik, though she used to be the only choice. It was no problem for me to leave with my referral at the end of my very first visit with my new pcp.
6. Get referrals to 2 mental health professionals. Dr. Stiller's office wanted this before the consult to be sure Medicaid would pay. I go to Community Healthcare and it wasn't a problem to send me down the hall from my doctors office to get a letter and then to a sister clinic 10 minutes away to get the other letter. It all seemed mostly a formality but ymmv I had been living as a woman full time for over 5 years at that point.
7. Schedule a consult. Dr Stiller's office called me in reference to the referral and I ended up scheduling the consult further out than I had to due to real life but as I understand it the date is usually 1-3 months from when you talk to them. They will send you a packet of wto fill out and bring with you to the visit.
8. Call your local Medicaid broker (people for people, Paratransit services, etc) and get them to give you a ride/reimbursement and to house you for the night to get to your consult. The office is in Idaho, though if you live in eastern Washington going there doing the consult and coming back without spending the night shouldn't be so hard.
9. Go to the consult. Write down your questions before hand, this is where you will learn if you need electro on your genitals (thankfully I didn't) and also if you need a skin graft (also didn't need thankfully) he also works with FTMs but I can't really speak to that consult expierence. Note, you are not going to come home with a surgery date, they will submit your paperwork to Apple Health.
10. Wait for your approval letter/the office to call you. This takes 2-4 weeks. I got my letter first that said I was approved for "intersex surgery, make to female" and the approval was valid for 6 months. The doctors office scheduled me for about 3 months out so there was still plenty of time on the approval if my date had to be moved. The office then sent me a bunch of additional paperwork detailing my pre-op appointments.
11. Talk to your medicaid broker again, it took a while to get the trip worked out since this one was pretty complicated, luckily they didn't fight when I said I wanted to be put up in the recovery house (which is way nicer than a hotel) and they didn't fight when I said I needed lodging even while I was in the hospital since I needed my partner there too and I didn't want to force her to stay in the hospital room with me (though the hospital provided a portable bed for this purpose. It was also fine to arrive a day before my appointments to ensure that I would make my peril apppintments without issue.
12. Check into the recovery house and all preop appointments and follow the doctors Instructions. Assuming no bad results from the preop tests and you follow bowel prep instructions and whatnot surgery will happen right on schedule.
13. Recover! If your timetable changes call your Medicaid broker to keep your transit home and lodging appointments accurate, if you need transportation to follow up appointments Gritman medical center will provide a van or after hours pay for a cab for your.
I am home from recovery but from signing up for Medicaid to getting surgery it took 11 months and could have been shorter if I had done things faster. My total out of pocket costs were probably about $200 for food during recovery, extra lube, pads, otc medication, etc. the biggest deal cost is time off work since my jobs short term disability excludes transgender surgery (though my medical leave was granted without issue). I was frustrated for years trying to pay for everything and Washington took care of it in less than a year
P.s written on my iPhone with autocorrect so some it might not all be right lol
