New Colorado Insurance Coverage Requirements Making Early Impacts

A new analysis from the Center for Improving Value in Health Care (CIVHC) shows an increase in access to coverage and utilization of gender-affirming care services among transgender, gender diverse, and non-binary (TGDNB) youth and young adults. The analysis, based on claims in the Colorado All Payer Claims Database (CO APCD), found that the rate of individuals receiving gender-affirming care has risen over 300% from 2016 to 2021.

Gender-affirming care typically refers to care received by a person whose assigned sex at birth doesn’t match their gender identity. Services can help address gender dysphoria, or the discomfort or distress a person feels when their sex assigned at birth doesn’t match their gender identity. Care can include social, emotional, behavioral, and medical care and encompasses anything from using a person’s pronouns, to social support, to gender-affirming confirmation surgery.

The American Academy of Pediatrics found that “despite some advances in public awareness and legal protections, youth who identify as LGBTQ+ continue to face disparities that stem from multiple sources, including inequitable laws and policies, societal discrimination, and a lack of access to quality health care, including mental health care.” Colorado is a leader in the nation in providing critical services to people experiencing gender dysphoria, which is part of a strong statewide focus on reducing health inequities at the state, provider, and community level.

In 2017, the Colorado Department of Health Care Policy and Financing’s (HCPF) Medical Services Board passed a statute for a comprehensive Medicaid transition-related care benefit. Since 2016, the number of gender-affirming care services for Medicaid youth and young adults has increased nearly 11-fold from over 1,800 in 2016 to over 11,500 in 2021, and five times the number of unique individuals are receiving services.

On October 13, 2021, Colorado became the first state to require comprehensive gender-affirming care as part of minimum, or “benchmark,” health care plans sold on the individual and small group markets, which accounts for about a quarter of the state’s insured population. Commercial plans are not required to comply until 2023, however, the new analysis shows commercial plans are already covering these important services with nearly nine times the number of services and five times the number of individuals receiving gender-affirming care since 2016.

In spite of the positive increases, the number of youth and young adults receiving care could be considered low compared to estimates of those in need. According to the CIVHC analysis, in 2021, approximately 11 out of 100,000, or .01% of individuals covered by Medicaid and Commercial, received care. However, based on estimates of the total number of TGDNB individuals in Colorado from the U.S. Census[1] and the Youth Risk Behavior Survey[2] and results of this analysis, only 20% of TGDNB youth and young adults are accessing care in Colorado through their health insurance.

It is important to note that not all TGDNB youth and young adults may feel they need gender-affirming care services. And, while the CO APCD provides an estimate of access, the claims may not capture all of the types of care individuals may be receiving, nor do all insurance companies cover essential services as part of gender-affirming care. Additional challenges may exist including insufficient numbers of providers trained in gender-affirming care resulting in long wait times, and payers asking patients to take additional steps like psychotherapy sessions before covering care.

CIVHC looks forward to continuing to track and support progress towards increasing access to these important health care services, and reducing health inequities for all Coloradans.

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