Today, advocates from across Illinois celebrate the final rule that regulates Medicaid coverage for gender-affirming surgery. The final rule prioritizes the patient and provider relationship, allowing Medicaid to cover life-saving, medically necessary procedures for trans and gender nonconforming people.

“I’m so relieved that I can finally look forward to feeling like myself, my whole self,” said Camillaa Lockett, community member and client at Howard Brown Health. “I could not afford the surgery that I need on my own. I’ve had Medicaid for a few years but have not tried to get surgery because I thought I wouldn’t get the coverage I need.”

Advocates from the AIDS Foundation of Chicago, American Civil Liberties Union of Illinois, Center on Halsted, Equality Illinois, Howard Brown Health, Lambda Legal, the National Center for Transgender Equality, and the TransLife Care Program of Chicago House and Social Service Agency, herald the revision of an antiquated Medicaid regulation, bringing to fruition five years of advocacy work for gender-affirming medical care in the IL Medicaid program.

A proposed rule by the State’s Medicaid agency, the Department of Healthcare and Family Services (HFS), was first released earlier this summer. That proposed rule passed the final step in the Illinois rulemaking process being published on January 3, 2020. The rule is being put into effect retroactively for December 23, 2019. This codification takes place after the updated regulation cleared the last hurdle of approval from the State’s Joint Committee on Administrative Rules (JCAR).

“A patient, working with their provider, should have access to life-saving medical care with no interruption or delay because of insurance coverage,” said Magda Houlberg, Chief Clinical Officer for Howard Brown Health. “Our organizations will continue working to ensure that providers and managed care plans understand this rule and that patients are able to access medically necessary care. Medicaid is a life line for thousands of Illinoisans, and now trans and gender nonconforming people will have better access to essential medical care.”

Advocates and impacted community members submitted two rounds of comments, wrote letters, shared their stories, and met with leadership in the Governor’s office and HFS to ensure the final regulation aligns with the current medical standards for the treatment of gender dysphoria and do not interrupt the patient-provider relationship by arbitrarily labeling necessary treatments as “cosmetic.”

Coalition members would like to thank Illinois Governor JB Pritzker; Deputy Governor Sol Flores; Theresa Eagleson, Health Family Services Director; and Governor’s Deputy Chief of Staff for Policy Ramon Gardenhire for supporting the changes and helping to craft rules that puts the patients first.

The final regulation was published January 3, 2020. The rule is being put into effect retroactively for December 23, 2019.

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