But policymakers have been slower to catch on. Currently, only Massachusetts, Oregon, California, Vermont, and the District of Columbia cover any sort of transgender care through their Medicaid plans, while only Colorado, Oregon, Connecticut, California, Vermont, Washington, Illinois, Maryland and the District of Columbia prohibit private insurers from refusing to cover them. Oregon remains the only state to offer puberty-suppressing medications for adolescents on its Medicaid plan.
“Oregon is leaps and bounds ahead of other states in making these steps,” says Kara Connelly, a pediatric endocrinologist at Oregon Health & Science University's Doernbecher Children's Hospital.
The treatment involves taking gonadotropin-releasing hormone analogs, which were originally used to treat precocious puberty in children, she says. It can be taken as a monthly injection or as implant. But either way, it's not cheap: The drugs can cost up to a $1,000 a month. Oregon's decision to offer them through its Medicaid program, Connelly says, will improve access for low-income kids who couldn’t otherwise afford them.
The move came as a surprise to many within the transgender-activism community, says Jenn Burleton, the executive director of TransActive Gender Center, a small Portland-based nonprofit that provides advocacy and referral services for gender-dysphoric youth.
Burleton says that when her organization first heard that the state was looking at adding transgender care to its Medicaid program, she and a group of doctors that work with TransActive contacted the Oregon Health Authority and asked to testify before a committee that evaluates proposed additions.
“We honestly weren't very optimistic it would be covered because we weren't sure that the conversation about transgender adolescents had entered the zeitgeist enough,” she says.
But in December 2012, the Oregon Health Evidence Review Commission, which prioritizes Medicaid spending, approved the subcommittee’s recommendation that puberty-suppressing drugs be covered by Healthy Kids Oregon, the state's Medicaid program for minors.
According to Karynn Fish, spokesperson for the Oregon Health Authority, children 18 and younger make up about 45 percent of the 935,026 Oregonians receiving coverage through Medicaid. The agency does not have numbers on how many transgender youths are covered, but according to Fish, the number is likely very small.
To get the treatment, young people will meet with a counselor for mental-health evaluation, which is now also covered by Healthy Kids Oregon. Once they've been diagnosed with gender dysphoria, they will meet with an endocrinologist to find out where they are in their hormonal development and when they can begin taking the drugs. The added coverage also includes follow-up treatment and related care.