June 29, 2021
NYS Office of Mental Health and Department of Financial Services Announce NY Insurance Carriers Complying with State Requirements To Provide Coverage For All Gender-Affirming Treatments
New Policies will Help Transgender People Obtain Appropriate Treatment for Gender Dysphoria
The NYS Office of Mental Health (OMH) and Department of Financial Services (DFS) today announced that insurance carriers in New York are complying with new State requirements to provide coverage for all gender-affirming treatments for gender dysphoria. Previously, many of these plans excluded some or all gender-affirming treatments as cosmetic.
Gender-affirming treatments, including hormone therapy, psychotherapy or surgery are prescribed to treat gender dysphoria, the high level of psychological distress and discomfort that affects some people whose gender identity differs from the sex they were assigned at birth or their sex-related physical traits.
OMH Commissioner Dr. Ann Sullivan said, “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.”
Superintendent of Financial Services Linda A. Lacewell said, “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.”
Last year, the New York State Office of Mental Health, working closely with the Department of Financial Services (DFS) required issuers of NYS-regulated insurance policies to develop evidence-based and peer-reviewed criteria to be used when making medical necessity determinations for the treatment of gender dysphoria. The carriers were required to submit their criteria to OMH for review and approval. To date, the criteria of 27 insurance carriers, with 48 lines of business, have been approved.
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 and DFS have worked with the NYS Department of Health and the Office of Addiction Services and Supports to implement a strong regulatory framework to ensure that insurance carriers are complying with parity laws and are using appropriate criteria to make coverage determinations for addiction and mental health services.