Academic journal article Fordham Urban Law Journal

Fixing Medicaid to "Fix Society": Extending Medicaid Coverage of Gender-Affirming Healthcare to Transgender Youth

Academic journal article Fordham Urban Law Journal

Fixing Medicaid to "Fix Society": Extending Medicaid Coverage of Gender-Affirming Healthcare to Transgender Youth

Article excerpt

Introduction. I.   Medicaid Coverage of Gender-Affirmng Healthcare      A. Definitions and Terms Used to Discuss Gender         Affirming Healthcare      B. Diagnosis and Treatment of Adolescent Gender         Dysphoria         1. Diagnosis of Adolescent Gender Dysphoria         2. Occurrence of Gender Dysphoria Among Children            and Adolescents         3. Treatment of Gender Dysphoria Among            Adolescents      C. Medicaid Coverage of Gender-Affirming Healthcare         1. Federal and Private Insurance Coverage of            Gender-Affirming Healthcare         2. Three Approaches to Medicaid Coverage of            Gender-Affirming Healthcare         3. New York's Medicaid Coverage of Gender            Affirming Healthcare         4. New York's Age-Based Limitations of Medicaid            Coverage for Gender-Affirming Care II.  Conflicts Doctrine and Law That May Arise From Medicaid      Age Restrictions on Gender-Affirming Healthcare.      A. The Medical Community's View as to the Medical         Necessity of Gender-Affirming Treatment for         Individuals Under the Age of Eighteen      B. Age Restrictions on the Access to Gender-Affirming         Healthcare May be Inconsistent with Principles of         Informed Consent         1. Support for the Age-Based Restriction as a            Mechanism to Enforce the Doctrine of Informed            Consent         2. Age-Based Restrictions May Conflict with            Exceptions to the Doctrine of Informed Consent      C. Age Restrictions May Give Rise to Legal Claims         1. Age-Based Restrictions Could Give Rise to Claims            Under the Affordable Care Act         2. Age Restrictions May Be Vulnerable to Challenges            Under the Reasonable Standards Requirement of            the Medicaid Act            a. The Medicaid Act Conditions Federal Funding               of State Medicaid Programs on Certain               Requirements            b. Programs That Restrict Coverage of Gender               Affirming Healthcare May Be Interpreted as               Unreasonable III. Proposal for Medicaid Regulations That Extend Coverage      to Transgender Youth      A. Necessary Provisions for a Trans-Inclusive Medicaid         Program to Meet Medical and Legal Standards         1. States Should Align Regulations with WPATH            Standards            a. Aligning Regulations with the WPATH               Standards of Care Would Determine Coverage               on an Individual Basis Rather Than a Fixed               Age         2. New York Should Align Its Regulation with the            Exceptions for Informed Consent      B. Policy Justifications for Extending Medicaid Coverage         of Gender-Affirming Healthcare         1. Replacing the Age-Based Restrictions Will            Resolve the Disparity in Health Coverage That            Youth May Receive When in Custody of the State         2. Removing Age-Based Restrictions Will Allow            Individuals to Obtain Benefits Based on Their            Legal Sex Without Delay         3. Mental Harm and Risk of Violence That            Transgender Youth Face Without Treatment.      C. Cost Justifications for Extending Medicaid Coverage         of Gender-Affirming Healthcare to Transgender         Youth         1. Removing the Age Restriction Would Impose a            Marginal Cost on States That Have Extended            Medicaid Coverage for Gender-Affirming            Healthcare         2. Removing the Age Restrictions Would Avoid            Other Costs Conclusion 

INTRODUCTION

In the early hours of December 28, 2014, a seventeen-year-old transgender girl named Leelah Alcorn left her home in Kings Mills, Ohio, and walked three miles to Interstate 71. (1) Before leaving, Alcorn had set up her Tumblr (2) account to automatically upload a post entitled "Suicide Note." (3) At 2:20 AM, Alcorn walked onto the six-lane highway and stepped in front of a tractor-trailer. (4) A few hours later, the post appeared on Alcorn's Tumblr page: "If you are reading this, it means that I have committed suicide and obviously failed to delete this post from my queue. …

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