Maryland lawmakers are considering a bill, the Trans Health Equity Act, that would extend coverage of gender-affirming care to residents on Medicaid, the health care plan for low-income and disabled people.

Here’s some frequently asked questions about the bill.

What is gender-affirming care?

On Saturday morning, the Maryland House of Delegates passed a bill that would allow trans, intersex, two-spirit and other gender-diverse residents who are enrolled in Medicaid to obtain comprehensive gender-affirming care. On Monday, the Senate also approved the bill.

Gender-affirming care is a blanket term used to describe any care provided to a person who is not cisgender — or someone whose gender identity corresponds with their sex at birth — to help them feel more at home in their own bodies. The federal government has named it an “essential health benefit” under the Affordable Care Act.

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Some gender-affirming care is currently covered by Maryland Medicaid. But dozens of procedures — everything from laser hair removal, to voice therapy, to more invasive surgeries — are not.

In 2022, 98 people sought gender-affirming care under Medicaid. According to a legislative analysis, if it becomes law, that number is expected to increase by an additional 25 individuals per year.

The comparably small number of Marylanders this bill would affect does not in any way detract from its importance, said Margo Quinlan, who works with the Mental Health Association of Maryland and is an organizer with the Trans Rights Advocacy Coalition.

“These are issues of life and death in our community,” Quinlan said.

How much will this cost?

With this addition, the impact on the state’s Medicaid budget is 0.005%, and, advocates argue, it’s a cost-saving measure as it will likely prevent the need for further treatment as a result of events such as suicide attempts.

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“We’re not expecting this bill to open the floodgates,” said Ashley Black, the lead attorney for the health and benefits equity project with Public Justice Center in Baltimore, during the initial committee hearing Feb. 14.

Legislative analysts did not put a figure on the possible cost, but wrote costs would “increase by an indeterminate but likely significant amount” within several years. That’s because the percentage of cost the federal government pays for gender-affirming service would decrease from 90% of costs to roughly two-thirds of costs.

The cost of individual procedures cited by analysts ranged from $800 for voice therapy or lessons to more than $50,000 to transition from one gender to another. If 125 individuals received all of the eligible services, analysts concluded, it would cost the state an additional $7.6 million. If that same group only received some of the eligible services, analysts wrote the additional state cost would be $2.1 million.

Does this apply to minors?

Though much of the debate in both chambers centered around the objections to the idea of invasive surgeries being performed on children, the reality is age is not even mentioned in the bill.

Further, the bill does not change existing Maryland Medicaid policy of not operating on trans youth. Trans people under age 18 are prescribed reversible puberty blockers and hormone treatment. Additionally, all health care decisions for transgender youth in Maryland require parental consent.

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What’s next?

The bill has been approved by lawmakers in both chambers and seems likely to become law this year.

Comparable legislation has been passed in at least nine states, including Virginia and Washington, D.C.

Quinlan, who has been at the forefront of this fight for years, said this year has been a turning point. The Trans Health Equity Act was not passed last year, so she finds the number of supporters it had this year to be inspiring.

Now, she said, the Trans Rights Advocacy Coalition can turn their attention to other issues.

“I think we’re gonna walk away from this session in a pretty good place to dig deeper on some of that work,” Quinlan said.

Callan Tansill-Suddath covered the Maryland General Assembly for The Baltimore Banner. She previously covered the beat for WYPR 88.1, and Capital News Service, and reported on Montgomery and Prince George's Counties for WAMU/DCist. A native of Silver Spring, Callan holds a Master of Journalism degree from the University of Maryland.

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