Yesterday the federal government published clarifying guidance further implementing the Affordable Care Act (ACA) to ensure access to critical preventive care for women and transgender patients. This guidance provides important information for both insurance companies and patients accessing care through the ACA. The FAQs published jointly by the Department of Health and Human Services (HHS), Department Labor (DOL), and the Treasury Department clarify coverage of preventive services explicitly providing that insurance companies cannot limit preventive services based on an individual's sex assigned at birth, gender identity, or their recorded gender identity. This clarification will ensure that individuals have access to the lifesaving screenings and services they need regardless of their gender identity.
Although this may seem like common sense, transgender patients seeking this preventive care have been routinely denied these services. The federal government has been an active leader on ending these unnecessary denials. In 2011, the Office of Personnel Management, which operates the Federal Employee Health Benefits Program, advised all participating insurers that companies must provide appropriate benefits based on medical status rather than gender identity. The Veterans Health Administration (VHA) issued a similar directive ensuring that transgender veterans have access to medically necessary care in VHA facilities in 2011.
In addition to addressing preventive care for transgender individuals, this guidance also clarified insurance companies' obligation under the ACA to provide coverage for contraception and well-woman visits, genetic screening for women with increased genetic risk for breast cancer, coverage for dependent children, and anesthesia for certain preventive screenings.
To learn more about this guidance visit: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf