Denying gender-affirming care to adults on Medicaid is inhumane, hurts Kentucky | Opinion

As health care providers caring for gender diverse people in a myriad of ways, are writing with true and authentic alarm concerning House Bill 495. At the last possible moment that didn’t allow for any discussion or review, this bill incorporated an unrelated ban on funding for gender affirming care. It eliminates all Medicaid coverage for an evidence based treatment for adult citizens who are fully competent to make their own health care decisions.

Make no mistake — cutting off Medicaid funding is effectively prohibiting essential healthcare for most, if not all gender diverse Medicaid recipients. Many of our patients, as Kentucky citizens, who work multiple jobs to support themselves and their families, rely on Medicaid to provide for a full spectrum of healthcare services.

We have grave concerns for the mental health and physical safety of our patients if HB 495 is implemented. There is ample medical evidence demonstrating that gender-affirminng care improves mental health and reduces suicidal thoughts and attempts. There is extremely low regret for any aspect of transitional care (much less than experienced for common plastic surgery procedures undergone by anyone.) Most often when gender diverse individuals pause care or de-transition, it is related to lack of insurance or societal or family pressure rather than regret.

If access to care is greatly reduced, we can only expect a huge downturn in mental health. This phenomenon will increase costs and decrease productivity for our state. Just as important are the physical risks that forced detransition would pose. Anti-trans sentiment is widespread and the rate of violence toward transgender people is increasing from an already high level. Furthermore, because many transgender people live in rural areas where they seldom encounter people who didn’t know them in a differently appearing body, this unwanted, forced de-transition could provoke more attacks and assaults. We absolutely should not put our citizens in this more vulnerable and unsafe situation.

Government interference in personal medical decisions informed by health professionals with years of training, as proposed by HB 495, sets a very concerning precedent of usurping the autonomy of adult citizens who have the right to their own bodies, minds and health. Putting the government in charge of autonomous people’s personal decisions that have no impact on others is not part of any party platform or written in the Constitution. Ultimately, what other medical conditions or treatment plans could also fall under the auspices of substituted medical decision making by our government? Might individuals access to care for treatments for diabetes, dementia, substance use disorders, liver failure, or safe pregnancy care be next? Ultimately, restricting Medicaid funding will cause worse disparities that would likely cost the state more in health care costs in the near future.

Gender dysphoria and gender incongruence are conditions recognized by all major medical specialties and allied health organizations; as well as the International Classification for Diseases. Hormone therapy (and surgical therapy) for these conditions is evidence-based to improve mental health and reduce suicidal thoughts and actions. These therapies are endorsed by the Endocrine Society, the American Medical Association, the American Psychiatric Association, the American Psychological Association, the American College of Obstetrics and Gynecology, and the American Academy of Family Physicians amongst others. This therapy is essential to the health of many Kentuckians who are making well-thought-out decisions under the advice of board certified physicians and advanced practice providers.

We are firm in our request that legislators and our fellow citizens respect the hardworking citizens of Kentucky who benefit from Kentucky Medicaid, by allowing them to strive to improve their health, contribute to the economy of our Commonwealth, and live their lives without government regulation of their personal health care. We also request that our autonomy, training and experience as medical professionals be respected as the best advisors to our patients in terms of their health care. Every person in this Commonwealth has a friend, family member or neighbor who does not fit in a strict 2 piece gender code. These people that you know, love, and respect are too vulnerable right now to be visible, discuss their experience and express their fears.

We as their providers must do it, and hope that all of our citizens can also advocate for these humans and against threats on their existence as themselves.

This piece was signed by the following Kentucky physicians and health professionals: Mara Arterburn, DO; Joanne Brown, DNP; Lesia Chaffins, PA; Keisa Fallin-Bennett, MD; April Haneline, Ali Khan, MD; APRN; Sarah Marks, MD; Curtis Montague, LCSW; Joanna Morse, PsyD; Martha Parks, LCSW; Eli Pendleton, MD.