NY expands rules for gender surgery

ALBANY - Nurse practitioners in New York can now refer Medicaid patients for gender-reassignment surgery, provided they have a background in psychiatric care.

The state Department of Health formally adopted a rule Wednesday adding psychiatric nurse practitioners to the list of medical professionals who can recommend the surgery, in which a transgender person's sex is changed to match the gender they identify with.

Under state regulations, a Medicaid patient must be diagnosed with gender dysphoria by two medical professionals in order to receive coverage for the procedure. Previously, one of those referrals had to be from a psychologist or psychiatrist, while the other could come from a psychologist, psychiatrist, physician or a licensed clinical social worker.

Now, psychiatric nurse practitioners have been added to both lists.

"(The) regulation is intended to strike a balance between enabling access to services and ensuring that Medicaid coverage of (gender-reassignment surgery) is based on determinations of medical necessity made by individuals qualified to make such determinations," the Department of Health wrote in Wednesday's State Register.

The new rule was first proposed in November.

Along with the nurse practitioner change, the state also tweaked its minimum age requirement for the surgery, which had been set at 18 unless the procedure would result in sterilization, in which case it was 21.

Now, the minimum age is 18 for all patients.

Michael Silverman, executive director of the Transgender Legal Defense & Education Fund, called the split age limit "arbitrary," saying those age 18 to 21 should have the same access to the procedure.

By expanding the list of medical professionals who can give referrals, Silverman said it will help transgender New Yorkers get the "medically necessary care they need."

"The Department of Health’s action will increase the pool of Medicaid professionals who can refer transgender New Yorkers for treatment, easing the way for them to get essential medical care that will improve their health and well being," he said.

New York first began allowing Medicaid reimbursement for gender-reassignment surgery in late 2014 after a class-action lawsuit was filed earlier in the year.

The newly adopted rule tweaks the original regulations that were put in to place.

During a public-comment period, the state heard from individuals and advocacy groups who wanted to see the referral lists broadened further to include general nurse practitioners and mental-health counselors, among others.

The state declined to expand their proposal further.

"The Department will take the commenters’ suggestions under advisement, but continues to believe the current requirement is reasonable and is not a barrier to transgender individuals accessing necessary care," the health department wrote.