Colorado first in nation to include gender-affirming care in some health care plans as essential benefit

By: - October 13, 2021 4:45 am

Gov. Jared Polis delivers his State of the State address in front of the House of Representatives at the Colorado Capitol on Feb. 17, 2021. (AAron Ontiveroz/The Denver Post, pool)

Colorado has become the first state in the nation to require comprehensive gender-affirming care as part of minimum, or “benchmark,” health care plans sold on the individual and small group markets, which accounts for about a quarter of the state’s health care customers.

The gender-affirming care element was announced during a Tuesday news conference that included speakers Gov. Jared Polis and Chiquita Brooks-LaSure, administrator of the federal Centers for Medicare & Medicaid Services. Brooks-LaSure, whose agency had to approve additional benchmark items, called the move “momentous” and said “gender-affirming care can be life-saving.”


“Health care should be accessible, affordable and delivered equitably to all, regardless of your sexual orientation or gender identity,” Brooks-LaSure said. “Today’s expansion of Colorado’s essential health benefits to include gender-affirming surgery and other treatments is an important step towards ensuring equity and access to care for Coloradans.”

She noted that other states could follow Colorado’s lead.

“Today marks the first time that a state has sought to add additional gender-affirming care as an essential health benefit,” Brooks-LaSure said said. “We hope this marks an historic beginning and that other states look to Colorado as a model.”

Besides surgery, such care could involve hair removal and other services. Gender-affirming care “is another way of describing the mental and physical health services that help align a transgender person’s body into alignment with their gender identity,” according to a press release from the governor’s office. The release says that while insurance companies already must cover some form of gender-affirming care, such coverage varies greatly by company and may exclude services that a health care provider has determined to be medically necessary.

The gender-affirming care will be included in plans sold in Colorado on the individual and small group markets starting in 2023. It does not apply to insurance obtained through large employers. New benchmark items also include an expansion of behavioral health care, including an annual mental health exam, and more options for substance abuse treatment, which were required as part of this year’s House Bill 21-1276.

Colorado Division of Insurance Commissioner Mike Conway said during the briefing that the cost for these additional essential care elements will be “negligible” — 64 cents per month per enrollee in the individual and small group market plans.

“This all adds to our efforts to develop the Colorado Option, not just to make care better and more affordable, but to make it more equitable as well,” Conway said during the briefing.

The Colorado Option is a standardized plan, created by state lawmakers this year, that private insurance carriers must offer themselves as an option on the state’s exchange for individuals and small businesses. 

“Every person deserves access to the full range of health services they need, and I’m proud that Colorado is leading the way to cover comprehensive care for LGBTQ+ people in our state,” said Rep. Brianna Titone, D-Arvada, one of the first transgender lawmakers elected in the country, in a statement. “For too long, too many transgender and nonbinary people have struggled to access the health care they need, despite having health insurance. These services are critical for the health and safety of LGBTQ+ communities and will provide more Coloradans with the agency they need to affirm their identities.”

Editor’s note: This story was corrected on Oct. 14, 2021, to state that the new benchmarks do not apply to insurance obtained through large employers.


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