California Says Insurers ‘May Not Deny Coverage’ For Mastectomy Regarding Transgender Individuals Based On Age

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Shelby Talcott Senior White House Correspondent
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The California Department of Insurance announced that implementing “strict age limits for gender transition surgery” regarding health insurance for transgender individuals is not allowed.

California has already taken steps in changing coverage “involving services for gender dysphoria,” noting on Dec. 10 that the Department of Insurance will use “the most recent version of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People.”

On Dec. 30, Insurance Commissioner Ricardo Lara clarified current California law following a request from San Diego’s TransFamily Support Services. The letter, written by the support services’ executive director, Kathie Moehlig, asked if a health insurer is allowed to deny mastectomies for an individual transitioning from female to male “based solely on the patient’s age.”

Moehlig and Lara referred to the procedure not as a mastectomy, the medical term for surgically removing a female’s breasts, but as “male chest reconstruction surgery.”

“An insurer may not deny coverage for male chest reconstruction surgery for female-to-male patients undergoing treatment for gender dysphoria based solely on a patient’s inability o meet a minimum age threshold because insurers must consider a patient’s specific clinical situation to determine actual medical necessity based on evidence-based standards of care,” Lara wrote in a response letter.

Lara applauded the move in a press release issued by the California Department of Insurance. The clarification does not exclude insurers from denying coverage for other reasons, but does prohibit them from doing so solely based on age – potentially making it easier for individuals under 18 to undergo gender-transforming related surgeries. (RELATED: California Becomes First State To Legally Recognize A ‘Third Gender’)

“For far too long, individuals diagnosed with gender dysphoria have had to battle a host of challenges to get access to gender-affirming care in order to be their true selves,” Lara said in the press release. “Social stigma, misconceptions about gender dysphoria and its treatment, and outdated medical criteria create barriers to necessary medical care that can lead to tragic results for individuals with gender dysphoria, especially for our transgender youth.”

Protections regarding transgender individuals and health insurance have been in place in California for years. In 2012, for example, the Department of Insurance implemented various regulations that forbid insurers “from denying, canceling, and limiting or refusing insurance coverage based on gender identity, expression or transgender status.”

At that time, California also announced that insurance policies couldn’t “arbitrarily” exclude coverage for various services and procedures surrounding transgender individuals. California also has the Insurance Non-Discrimination Act of 2006, which ensures all individuals the right to “medically necessary” health care regardless of how they identify, the Transgender Law Center noted in a press release from 2013.