For transgender Americans, access to necessary health care can be fraught with challenges.
Not surprisingly, the Obama and Trump administrations took very different approaches to ACA Section 1557.
But the Biden administration has reverted to the Obama-era rules.
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In 2020, the Trump administration finalized new rules that rolled back the Obama administration’s rules.
The Trump administration’s rule was subsequently challenged in various court cases.
Section 1557 of the ACA applies those same non-discrimination rules to health plans and activities that receive federal funding.
For private insurers, federal funding includessubsidiesfor their individual market enrollees who purchase coverage in theexchange(marketplace).
Are Health Plans Required to Cover Gender Affirming Care?
They are required, however, to make coverage decisions in a non-discriminatory manner.
That is still true under the Biden administration’s interpretation of Section 1557.
But that was vacated by a federal judge in 2019.
And the implementation of Section 1557 has been a convoluted process with various changes along the way.
Most recently, the Biden administration has restored nondiscrimination protections based on gender identity.
Do Health Insurance Plans Cover Sex Reassignment?
It depends on the health insurance plan.
But although health coverage for transgender-specific services has become more available, it is still far from universal.
But you may find that a different health plan simply covers your needs more comprehensively.
U.S. Department of Health and Human Services.Section 1557: Protecting individuals against sex discrimination.
Health Affairs.HHS will enforce Section 1557 to protect LGBTQ people from discrimination.
Federal Register.Nondiscrimination in health programs and activities.
U.S. Department of Health and Human Services.Section 1557 Final Rule: Frequently Asked Questions.
KFF.The Biden administrations final rule on Section 1557 non-discrimination regulations under the ACA.
U.S. Department of Justice Civil Right Division.Title IX of the education amendments of 1972.
U.S. Department of Health and Human Services.Nondiscrimination in health programs and activities.
Health Affairs.Court vacates parts of ACA nondiscrimination rule.
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Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission.
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