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TransActive Secures Coverage for Trans Youth Puberty Suppressing Treatment
Physician recommended puberty suppressing treatment of transgender adolescents has been added to the Oregon Health Plan and Oregon Healthy Kids program. This marks the first time any local, state or federally funded program has added such coverage.
At the recommendation of the Oregon Health Plan (OHP) Values-based Benefits Subcommittee (VbBS) on Thursday, December 13th 2012, and subsequently approved by the Oregon Health Evidence Review Commission (HERC), on January 10, 2013, it was confirmed that beginning October 1, 2014, the Oregon Health Plan will cover the cost of pubertal suppression evaluation, treatment and monitoring for youth diagnosed with Gender Dysphoria by a qualified mental health provider.
The guideline, as it will appear in the OHP ICD-10 Prioritized List, Line 521 states:
Hormone treatment is included on this line only for use in delaying the onset of puberty and/or continued pubertal development with GnRH analogues for gender questioning children and adolescents. This therapy should be initiated at the first physical changes of puberty, confirmed by pubertal levels of estradiol or testosterone, but no earlier than Tanner stages 2-3. Prior to initiation of puberty suppression therapy, adolescents must fulfill eligibility and readiness criteria and must have a comprehensive mental health evaluation. Ongoing psychological care is strongly encouraged for continued puberty suppression therapy.
Beginning October 1, 2014, Oregon Health Plan will cover:
The coverage will not take effect until October 1, 2014 and will not apply to treatment or services rendered or billed prior to that date.
“The $1,000 'out-of-pocketmonthly cost of pubertal suppression treatment is out of reach for most families,” said TransActive Executive Director, Jenn Burleton.
“Pubertal suppression provides transgender adolescents the option of avoiding unwanted, irreversible and deeply distressing changes that come with birth-sex pubertal development,” Burleton said. “Far too often trans adolescents experience increased suicidal ideation as a result of these changes and the indifference of others about the impact these changes have on trans youth.”
“Thanks to this common sense, safe and medically recommended action by the Oregon Health Plan, lives will be saved and TransActive is extremely grateful to have been able to play a part in this victory and to be a regional and national center for providing the care needed by these kids and their families.”
This landmark, first-of-a-kind decision came after more than a year of meetings and review of the testimony and evidence provided to the OHP Values-based Benefits Subcommittee by a team consisting of TransActive staff and members of the TransActive Advisory Board Medical Committee. The team included:
Lending invaluable support in this effort, particularly regarding the inclusion of mental health care coverage for adults was staff and members of the Basic Rights Oregon Trans Justice Working Group (TJWG). In particular, TransActive thanks the TJWG’S Program Director and TransActive Advisory Board member, Aubrey Harrison.
TransActive is a non-profit organization and is a recognized leader in trans youth care, services, education and advocacy. For more information please visit our website http://www.transactiveonline.org or email us at: firstname.lastname@example.org.