California Department of Insurance
First-in-nation regulations anchors brief on medically necessary care for transgender vets
SACRAMENTO,Calif. — An amicus brief filed yesterday by attorneys general from nine states and the District of Columbia on behalf of transgender veterans unfairly denied health care relies on regulations issued by California Insurance Commissioner Dave Jones.
The amicus brief in Fulcher v. Secretary of Veterans Affairs, which is before the U.S. Court of Appeals, defends transgender veterans’ access to health care. Currently, transgender veterans are being denied medically necessary care by the U.S. Department of Veterans Affairs that every major medical association, including the American Medical Association and American Physiological Association, agrees is medically necessary and proven to improve and save lives.
“The discriminatory policy of the Veteran’s Administration should be rescinded,” said Insurance Commissioner Dave Jones. “We must defend the rights of transgender veterans who are denied access to health care services.”
California state law prohibits discrimination by private insurers and in Medi-Cal coverage. In 2012, Jones issued the first regulations in the United States prohibiting health insurers from continuing practices limiting or denying health coverage for transgender policyholders simply based on their gender identity or expression. The department concluded that blanket exclusions targeting transgender persons while providing the same treatments and services to non-transgender policyholders was prohibited by California law.
“Today, when a transgender Californian purchases health insurance, they have equal access to medically necessary treatment.”
The California Department of Insurance also conducted the first government-sponsored economic impact assessment in the United States related to transgender health insurance coverage. The assessment concluded removal of the discriminatory exclusions would have an insignificant and immaterial impact on premiums and that the benefits for transgender Californians were significant.
After the Department of Insurance regulations were adopted, the Department of Managed Health Care applied virtually identical rules to the managed care companies they regulate. Additionally, CalPERS, which manages health benefits for over 1.4 million members and their families, used the Department of Insurance analysis to require coverage be free from discriminatory exclusions.
Since then, 13 states and the District of Columbia have used the department’s analysis and regulations as the basis for eliminating this type of discrimination. Just last year, when the U.S. Department of Health and Human Services issued federal regulations banning the practice, they relied heavily on the department’s work on the issue.