Medicaid coverage for gender-affirming surgery: A state-by-state review.

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Services Research Pub Date : 2024-06-17 DOI:10.1111/1475-6773.14338
Jonnby S LaGuardia, Madeline G Chin, Sarah Fadich, Katarina B J Morgan, Halena H Ngo, Meiwand Bedar, Shahrzad Moghadam, Kelly X Huang, Christy Mallory, Justine C Lee
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Abstract

Objective: To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage.

Data sources and study setting: Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals.

Study design: A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries.

Data collection/extraction methods: We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described.

Principal findings: Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (p = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (n = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (n = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate.

Conclusions: In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.

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性别确认手术的医疗补助覆盖范围:逐州审查。
目标:系统地审查各州的性别确认手术医疗补助政策:系统审查各州在性别确认手术保险方面的医疗补助政策:利用 LexisNexis 法律数据库、州立法机构出版物和医疗补助手册收集美国各州的原始数据:研究设计:一项横断面研究,评估医疗补助计划对多种性别确认手术的覆盖情况:我们以前曾报道过在医疗补助计划覆盖范围内保护性别确认护理的州卫生政策。在之前工作的基础上,我们对 27 个实行保护政策的州进行了系统评估,以确定每种性别确认手术的承保范围。我们分析了医疗补助在四个领域对性别确认手术的承保范围:胸部、生殖器、颅面和颈部重建以及其他手术。每类手术的医疗补助覆盖范围分为明确覆盖、明确不覆盖或未说明:在 27 个制定了医疗补助保护政策的州中,有 17 个州(63.0%)明确承保了至少一种性别确认胸部手术和至少一种性别确认生殖器手术,而只有 8 个州(29.6%)明确承保了至少一种颅面和颈部手术(p = 0.04)。在这三个解剖学领域中,具体手术程序的承保范围各不相同。最常见的明确承保手术是乳房缩小/乳房切除术和子宫切除术(n = 17,63.0%)。最常见的明确不承保手术是翻转手术(12 例,44.4%)。有几个州没有说明承保的具体手术,因此最终的承保率并不确定:2022 年,52.9% 的州制定了医疗政策,保护医疗补助计划下的性别确认护理;然而,各种性别确认手术的承保范围仍然各不相同,有时甚至没有明确规定。在明确规定的情况下,与胸部和生殖器重建相比,颅面和颈部重建是受保最少的解剖学领域。
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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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