Maryland House Passes Bill Requiring Gender-Affirming Care Under Medicaid

Maryland’s House of Delegates passed a bill on Saturday that would expand the state’s Medicaid program to cover gender-affirming procedures for transgender, intersex, nonbinary, two-spirit and all other gender-diverse people.

The Trans Health Equity Act, HB0283, would play an important role in ensuring that low-income transgender Maryland residents on Medicaid can have access to hormone therapy, puberty blockers, hair alterations, surgeries on the face and other parts of the body along with several other gender-affirming procedures that are often covered by private insurance.

According to data from the Williams Institute at the University of California, Los Angeles, 24,000 Maryland residents are transgender, and 6,000 are enrolled in Medicaid. In 2022, 98 transgender Maryland residents got gender-affirming care through Medicaid.

But the state’s Medicaid program currently only covers some gender-affirming procedures, including mental health services, hormone replacement therapy, and gender reassignment surgery for patients 18 and older who meet specific qualifications. Meanwhile, gender-affirming care is commonly covered by private insurance.

The legislation, a similar version to one that failed last year, passed in the House final vote by a count of 93-37. During the committee meetings, several Democrats spoke about their support for the legislation, including delegate Anne Kaiser who sponsored the bill.

“We don’t have representation in this House by anyone in the trans community. So myself and, my 59 co-sponsors we are your voice. We are your representation,” Kaiser said.

She continued: “We recognize that what is being said nationally … about trans people are the same lies that were said about gays and lesbians 20 years ago, and that’s part of the reason I feel the passion and the connection to our trans brothers and sisters, our neighbors, our community.”

House Republicans proposed an amendment to the bill on Friday that would prevent qualifying individuals under age 18 from being provided gender-affirming care — a move that reflects nationwide attacks on such life-saving health care for transgender youth.

“This is not about health. This is about male-to-female transition and female-to-male transition of children,” Delegate Mark Fisher, the Republican who proposed the amendment, said, according to the Baltimore Banner, sharing his concerns about minors being able to receive surgeries such as vaginectomies, mastectomies and penectomies.

But delegate Bonnie Cullison, a Democrat, emphasized that “this is absolutely about health.” Cullison countered Fisher’s argument by adding that the surgeries he’s concerned about would only be provided under extreme circumstances and when medically necessary and indicated for the individual’s health. The bill also states that all gender-affirming medical care would only be done after a consultation between a parent, patient and medical provider.

Fisher’s proposed amendment to bar minors from receiving gender-affirming care failed by 90-37, according to the Baltimore Banner. A second Republican-backed amendment aiming to prevent gender-affirming care to minors without the consent of both parents failed in the House by 91-36.

The legislation will now go to the Senate and, if passed, will be sent to Gov. Wes Moore, who has previously expressed support for the legislation. The bill’s passage in the House arrives amid the 426 anti-LGBTQ legislation sweeping the nation, from bans on drag shows to limits on gender-affirming care.