OMH: Gender-affirming treatments being covered by NY insurance companies

Health

ALBANY, N.Y. (NEWS10)- New York health insurance carriers are covering all gender-affirming treatments for gender dysphoria, as required by law. The finding was announced by the New York State Office of Mental Health (OMH) and the Department of Financial Services (DFS).

By law health insurance in the state must cover treatments once excluded by being deemed cosmetic like hormone therapy, psychotherapy, and surgery to treat gender dysphoria.

Gender dysphoria can result in extremely negative mental health outcomes, such as depression, substance use, and suicide. Yet many commercial insurance plans excluded coverage for needed gender-affirming treatments. Working with DFS under the direction of Governor Cuomo, we applied our authority to review the clinical review criteria used by insurance carriers to determine coverage for mental health treatment. I am very pleased that, as a result of these actions, insurers have agreed to update their policies to cover medically necessary gender-affirming treatments using appropriate criteria.

OMH Commissioner Dr. Ann Sullivan

Last year insurance carriers were required “to develop evidence-based and peer-reviewed criteria to be used when making medical necessity determinations for the treatment of gender dysphoria” and submit plans to OMH who worked closely with DFS. OMH said the plans of 27 insurance companies with 48 lines of business have been approved thus far.

Securing coverage for gender dysphoria is the latest milestone in New York’s efforts to guarantee that insurers comply with Federal and State Parity laws requiring they cover mental health and substance use disorder treatment at the same level that they cover other health conditions.

OMH

“DFS is pleased to see insurance carriers upholding gender-affirming care for New Yorkers who may need access to this medically necessary coverage, especially significant as we mark the end of LGBTQ+ Pride Month. DFS will continue to advance access to healthcare, creating a stronger and healthier New York for all,” said DFS Superintendent, Linda Lacewell.

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In addition to working with DFS, OMH said they have also worked with the New York State Department of Health, and the Office of Addiction Services to put together “a strong regulatory framework” to make sure insurance companies are complying with the law and determining treatment coverage using appropriate criteria.

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