Colorado sets a precedent: How the state’s gender-affirming health care coverage is doing, two months in

COLORADO SPRINGS, Colo. (KKTV) - In January, Colorado became the first state to include gender-affirming health care as an essential health benefit, or EHB.

Under federal law, each state is required to provide ten EHBs, such as prescription drugs and emergency services. Colorado is now including gender-affirming care as an EHB, to make it more affordable and accessible.

Advocates have pushed for this inclusion for years now, but the state’s Division of Insurance tells 11 News that formal conversations started back in 2021. After discussions and various approval processes, the Biden Administration officially signed off on Colorado considering gender-affirming health care an EHB.

This all means that those seeking those transition services should be able to use the health insurance they pay for to get the care they need, as long as they have an individual plan or a Colorado-based small group plan (employers with 2-100 employees).

While this isn’t a comprehensive list, the Division of Insurance (DOI) is offering a gender-affirming care coverage guide. This includes common services, as well as what some of the major providers cover.

Gender-affirming care can range from physical procedures, such as chest and genital surgeries, to mental and behavioral therapy.

“These are not cosmetic or optional,” said Sky Patron Health Equity Coordinator of One Colorado. ”These are medically necessary to allow folks to present in a way that aligns with their gender. And so when someone can feel like their body aligns with their gender identity, that feeling can change someone’s life.

Advocates such as those at One Colorado are driving home the point that while this is a big step forward, there are still health care barriers the LGBTQ+ community must navigate -- and often struggle to do so.

“It is confusing and there is not always clear guidelines about what you need to do to access the care that you’re entitled to through your insurance and through the law,” Patron explained.

A report by One Colorado shows that cost is also often a barrier. And it all depends on what you want to do -- is it chest surgery? Hormone therapy? Mental health care?

You may also need proof that your desired service is essential, such as letters from a medical professional.

DOI tells 11 News they wanted to make gender-affirming care in the state more accessible.

“Rather than just mimic what other states are doing, if it means helping Coloradans and it’s going to improve people’s lives, we’re going to take that step. And if it means being first in the nation, that’s okay, said Vincent Plymell with the DOI.

“I think really the most important aspects of this are going to be the lives that are going to be saved. And the lives that are be significantly improved because of this change.”

Advocates say a key reason for gender-affirming health care is to feel and look like how one identifies, and it can be harmful to prevent this.

“People who are not part of the [transgender], nonbinary, gender expansive community received gender-affirming health care in many ways that we don’t think of it in the same way, because it’s for cisgender people,” Patron explained. “But it’s still gender affirming, like taking hormones or getting certain reconstructive surgeries. So what we want for our community is the same access to the medically necessary life-saving health care that the rest of the community has.”

If you’re having trouble getting covered by your insurance, you can reach out to the Division of Insurance at 303-894-7490 or DORA_Insurance@state.co.us.

You can also visit their website and click on “File a Complaint.”

Plymell says if you between 8:00 a.m. and 5:00 p.m. Mondays through Fridays, there is typically no wait time.

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