This Media Campaign Is As Awesome As Trans-Exclusionary Medicaid Regulations Are Terrible

The mainstream media does a piss poor job reporting about trans issues and people. Grantland proved that last week with the Dr. V tragedy. Katie Couric proved it last month when she asked Laverne Cox and Carmen Carrera about their genitals. Newspapers and TV stations around the country proved it thoroughly last year in their coverage of Chelsea Manning coming out as transgender.

With the advent of the internet and all its related whatnots, it’s gotten easier for queer and trans people to make our own media that represents our values, goals and selves. We prove that every day here on Autostraddle. If you’re in the Northeast, you might have seen this awesome video:

It’s part of a media and activism campaign by the Sylvia Rivera Law Project, GLAAD, and TransJustice, a program of the Audre Lorde Project. The groups are demanding that New York repeal a law prohibiting state Medicaid recipients from receiving coverage for care related to transition, including hormones, supplies and surgery.

I hope in a couple generations, kids look at us like we are insane when we tell them about the current state of health care in this country (“But gramma, what do you mean there were children who couldn’t go to the doctor when they got sick?” is a question I want to have to answer). For trans people, especially trans women of color, the picture is particularly dire, since so often their care is deliberately excluded from insurance plans. In 2010, 19 percent of trans people reported having no health insurance at all, compared to 15 percent of the general population. According to the Injustice at Every Turn report, almost half of trans people report delaying needed health care because they can’t pay. Trans people have higher rates of HIV infection, smoking, drug and alcohol use, and suicide attempts than the general population. Of respondents, 19 percent reported being refused medical care because they were trans; the rate was higher among trans people of color.

Only five states, most recently Connecticut, require health insurance providers to cover transition care even though the American Medical Association recommends “public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.” (Sidenote: GLAAD advises that the term “gender identity disorder” is “a controversial DSM-IV diagnosis” and “because it labels people as ‘disordered’… is considered offensive.”)

TransJustice is a community organization with a membership of primarily middle-aged and older trans women of color, most of whom are receiving some kind of public benefits, Elliott Fukui, the coordinator of TransJustice said. When the state passed the regulation banning state Medicaid from covering transition related services in 1998 after pressure from the public, it was a huge blow to the community. The Sylvia Rivera Law Project has been working to expand access to health care for trans people since it began in 2002. TransJustice and GLAAD teamed up with the organization for the campaign that launched in November.

Public opinion and public policy are currently shifting to be more inclusive of trans people, said Elana Redfield, a staff attorney at the Sylvia Rivera Law Project. So the time is ripe for this kind of action.

“The [Governor Andrew] Cuomo administration has put out a lot of messaging that it wants to improve Medicaid even as it streamlines it and makes it more efficient,” Redfield said. “Even though they have more or less recoiled from the hot potato of trans health care, we think its possible to hold them to their word.”

Failure to cover trans care has no economic basis — cities and states that cover transition-related medicine, surgery and supplies report no or marginal increases to state costs. According to the Human Rights Campaign, “When the City and County of San Francisco made its employee insurance plans transgender-inclusive in 2001, it set up an additional per-employee per-month surcharge to offset the expected additional expenditures. By 2006, it had only spent $386,417 of the $5.6 million it had collected from this surcharge. It ended the surcharge completely.”

In fact, lack of care can be more expensive because patients who can’t receive care for their treatment through safe channels may turn to buying hormones off the street or get surgeries from unlicensed practitioners and then develop serious medical problems, according to Fukui. It’s politics, not economics or medical concerns, that drive the refusal to cover health care for trans and gender nonconforming people, he said.

“New York draws a lot of LGBT people, and people think that if they get here they’ll have access to the things they need,” Fukui said. “We have a very large trans population here, and folks are coming here and realizing that the things that happen everywhere are happening here and it’s not quite a liberal gay utopia they were hoping for.”

That’s why media campaigns like the one by this coalition are so critical. Many people have no idea of how broad and devastating the effects of policies like the one in New York can be, nor do they know what “trans health care” entails.

“We want people to know that trans-inclusive healthcare isn’t “special” healthcare,” said Dani Heffernan, GLAAD’s media strategist. “It’s the same healthcare that people who aren’t trans have access to when they need it, but it’s specifically denied to trans people under many health insurance policies, including New York State Medicaid.”

For example, menopausal women can receive coverage for estrogen treatment through Medicaid, but trans women are not eligible for coverage for the exact same treatment.

The media campaign focuses on simple data and ideas, incorporates the stories of people with a stake in the issue, and is visually compelling. The talking points are easy to share and make sense as audio, video and print materials.

Via Sylvia Rivera Law Project

Via Sylvia Rivera Law Project

The campaign has also included direct activism, like a banner drop at a December rally where New York State Health Commissioner Nirav Shah spoke and a petition. The New York Department of State Health Services did not return multiple requests for comment on the campaign or the rule.

Visibility for trans issues has boomed in the last three years, Fukui said, and media campaigns like this one are an important part of that change. But direct community action is still at the core of organizations like TransJustice, he added. The community drives the goals, and face to face interaction is necessary to stay grounded in the diverse and complex realities trans people experience.

“We recognize that as much as this is a gender thing, it’s also a racialized thing and a class thing. We also need to be mindful of how this will impact folks who are undocumented, folks who are in prisons and jails, folks who are in psych wards, and that those folks who are most marginalized are often the ones we don’t get to see,” Fukui said. Although this campaign is centered on New York, “We’re pushing for policy change, and we know these are issues across the board – there should be healthcare for everyone and we don’t have that in this country.”

Campaigns like this one make an impact on multiple levels. It elevates the voices of marginalized people, which empowers communities. It educates viewers on the topic at hand. And, it gives mainstream reporters tools to use when they report on the topic. Hopefully one day we won’t need YouTube videos that explain that trans people are human beings who need healthcare just like everyone else.

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Adrian is a writer, a Texan and a Presbyterian pastor. They write about bisexuality, gender, religion, politics, music and a whole lot of feelings at Autostraddle and wherever fine words are sold. They have a dog named after Alison Bechdel. Follow Adrian on Twitter @adrianwhitetx.

Adrian has written 153 articles for us.


  1. I am beyond thrilled that this campaign was started by SLRP, which is such an amazing and awesome organization. I do wish they were framing this more in terms of the whole state’s trans population, rather than just NYC’s. I understand they are an NYC based organization, and they mainly serve that population, so that obviously has a huge impact, but I hope that this campaign grows to include voices from people outside of the city.

    Prior to moving to Brooklyn a couple months ago, I was living in Syracuse (born and raised, upstate pride, etc…) and traveled five hours by bus to access informed consent hormone therapy that accepted Medicaid in NYC. There are no informed consent practitioners or clinics in Syracuse, let alone ones that accept Medicaid (there is a Planned Parenthood in Ithaca, NY that works on informed consent, but as far as I know, they are the only place outside of NYC in the state that offers this). I know NYC’s trans population is in as much a need for Medicaid coverage of transition related medical expenses, especially given the crowded clinics and overworked doctors and nurses who administer care to us, I just wish the rest of the state had a voice in this campaign.

  2. I love this campaign. There is so much bigotry around coverage for transgender care. I am currently fighting Group Health on the coverage of my testosterone because in my state they aren’t forced to cover me. I was told on the phone that they will never cover me even if my legal markers declare me male, I look male, I’ve had surgeries fit the heteronormative idea of male. Because I was once legally declared female, I will never ever be covered.

    This is in stark comparison to middle aged men, who can get testosterone prescribed at the drop of a hat for the medically dubious diagnosis of “low testosterone.”

    It is such a frustration, that I’m thinking of moving to Oregon, where state laws says they have to cover me.

  3. Thank you.

    It sucks that this shit is still going on.

    I transitioned in 1994, dropped out of grad school, found a job writing technical documentation that I eventually parlayed into writing code (which … pays well, if you’re good, and I managed to not starve before I figured out that “good” + “girl” meant “fuckin’ kick-ass” (and + trans meant “take no prisoners”)).

    A few years later, the company (contract programming agency) finally got around to getting insurance for all of us in no’th ca’lina (hq in dc always covered, of course; the sociopath^Wpresident was there). Sleazy insurance guy came in and talked to everyone in the office. I got a call: “We told him you’re a contractor, not a full-time employee. If we’d said you were full-time, nobody could have afforded the rates.” So: quietly agree to keep paying for everything that I might need (I wasn’t terribly well-compensated at this point, mind; that came later), or take the blame for keeping my friends (some sole earners with children) from having insurance. Me: quiet, trying to smile.

    Not a terribly compelling story, I know. It stuck with me, though, and this is the first place I’ve thought to share it.

    My current company insurance prolly pays more for my weekly therapy than they would have if they’d thought to underwrite another Italian suit for Dr. Toby. *That* they can’t complain about (different company than the anecdote above, mind, though I was on their insurance when I saved up four weeks of sick leave and six weeks of vacation to take myself off for surgery and recovery (and still had HR on my ass until my boss told them to fuck off, he’d approved it so I didn’t have to take unpaid medical leave)), because dealing with the depression and anxiety and stress is job-related, and they want me at my best. Right? Right.


    • Ugh, I’m sorry to hear that happened/still is happening. That’s really shitty that your company sold you out… and even more so that they were ever presented with that choice at all.

  4. My story isn’t particularly bad or anything but I believe it to be pretty standard. I moved to the NW for Americorps about 5 years back and began transitioning a few months later when I realized I couldn’t put it off any longer and being in a more supportive city with lots of trans resources, it seemed the best time to start over with no more delay.

    After accessing mental health care in an attempt to get my hormone letter, I was told it would take me about 3 months of therapy before I could access that letter. I started taking black market hormones, and during that time I fucked up my system for a few weeks taking too much testosterone blockers when my E ran out, resulting in limb pain and rashes and a few other side effects. I ended up telling a physician, who prescribed those hormones right away without my therapist’s suggestions.

    Flash forward a year, to when I am getting out of Americorps, the government had been paying my health care costs and transition-related costs for the rest of the year, no problem. A month after being out of Americorps, where I had been doing service work at poverty wages for the american government, I began getting bills from their health insurance provider RETROACTIVELY DENYING every one of my transition related care costs from that year. I pretty much only accessed physician care and hormone prescriptions. I paid everyone of my therapist bills out-of-pocket off a sliding scale (because, again, poverty wages and such), I think the total costs that year were about $3,000 dollars that I was then on the hook for, but I wouldn’t know that, they just kept sending me bills of $200 every month until they got every red cent back.

    Now, I finally have health-care through a new job that I love very much and pays for all of my premiums, but I am worried that it won’t be much of a help, as my provider, Group Health, is known for shirking costs on trans-related care, which is easily my biggest and most recurring cost yearly.

    The other day (before getting my insurance) I was charged $250 dollars to get blood drawn just to look at my liver levels and hormone levels. From a community clinic which specializes in serving people experiencing homelessness. I wasn’t consulted about the cost before getting the test. Also, I had to have the test before I could get my prescription for the next 3 months of hormones. So I am expected to pay $300 every 3 months just to be able to feel my like myself?

    Fucking gatekeepers, yo.

    • My experience with group health is that if your state doesn’t compel them to cover, which is only California, Colorado, Vermont, Oregon, and Connecticut, that the company contracting to get the insurance with group health has to have a rider specifically including transgender care.

      If you are stealth, and everyone thinks you are the gender you look like, you might be able to fly under the wire, but they’ll demand back payment if they find out.

      I can’t get my lab levels for testosterone covered, but I can get my liver checked through my regular GP. I’m really careful about who tests what. I get my GP to do all the liver, cholesterol, etc checks first, then I take them to my trans doc, and have her do the testosterone levels.

      I hate Group Health. They suck.

      Also, Lamda Legal is looking for transgender people as good court precedent cases to fight this. It’s an possibility if your situation looks promising from a court case side.

  5. “It’s politics, not economics or medical concerns, that drive the refusal to cover health care for trans and gender nonconforming people, he said.”

    So many rights denied to people when it doesn’t even benefit anyone. Makes me tired.

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