Photo, above: transgender teen denied gender-affirming care under MCSIG policy (via Monterey County Weekly).
Transgender people face discrimination and violence throughout society, from their family growing up, in school, at work, by homeless shelters, before judges, by landlords, by law enforcement, by doctors, and in emergency rooms.
For many transgender individuals, seeking and accessing health care can be especially difficult, and nearly impossible for some. This was the case for a teenage transgender man who approached CRLA in late 2019 regarding a transgender care ban in his health care coverage.
State Law, Courts Hold Transgender Exclusionary Policies Illegal
Our client’s mother is a schoolteacher, and her school is part of a large “self-funded” health insurance plan that covers most of the school districts throughout California’s Central and South Coast, MCSIG (Municipalities, Colleges, Schools Insurance Group). MCSIG’s plan, which currently covers approximately 12,000 people, denied all coverage for gender-affirming care to its clients.
It is illegal in California to discriminate against individuals because of their gender identity, and a policy that singles out gender-affirming care necessarily singles out transgender individuals.
In addition to state law, courts across the country have held that transgender exclusionary policies in self-funded plans like MCSIG’s are illegal under the Equal Protection Clause of the 14th Amendment to the US Constitution and Title VII of the federal Civil Rights Act.
Still, MCSIG persisted in the belief that their plan and policies were legal.
Community Campaigns to Remove MCSIG Gender-affirming Care Ban
Through community networks, CRLA was able to contact other transgender employees and dependents and found that MCSIG’s policies continued to cause harm and resulted in substantial costs to clients who were forced to seek care out of pocket or go without the care they needed.
CRLA has been deeply involved in a community-led campaign to remove the gender-affirming care ban from MCSIG’s policies. We have worked with teachers, school administrators, union members and representatives, and community advocates.
After months of working with community advocates pushing for change, CRLA served a demand letter on MCSIG. The demand letter served as a rallying point for advocates, who banded together to provide public comment and communicate with MCSIG’s governing bodies.
In June 2020, following eight months of work and persuasion, MCSIG’s board voted to repeal its gender affirming care ban and adopt a policy that provides access to care for its transgender clients.
A Momentous—but Incomplete—Victory
When MCSIG’s Board voted to remove the gender-affirming care ban, it was momentous—it marked a huge change in the makeup of the plan for transgender plan members or dependents. This victory is not whole, however, as few victories are.
The work toward comprehensive gender-affirming care continues. MCSIG chose a plan, Anthem, that is one of the most restrictive insurance plans for gender-affirming care on the market. The plan covers genital surgery but excludes most of the procedures sought by transgender women, including voice therapy, breast augmentation, and hair removal.
CRLA continues to work with community advocates to urge MCSIG to amend their decision and adopt a plan that does not discriminate against any transgender individual.
Advocacy for LGBTQ+, Rural Health Care Access Continues
Access to gender-affirming care can be the difference between mental and physical health and serious medical issues for many transgender individuals.
Community lawyering makes a measurable impact on health outcomes, especially for vulnerable individuals and families. CRLA is proud to be part of the movement to provide access to culturally competent, expert medical care for LGBTQ+ clients and all rural California communities.
- Read more about our client’s story in the Monterey County Weekly
- Donate to CRLA and support our LGBTQ+ advocacy