Few private policies cover sex changes

The vast majority of private insurance carriers and self-insured employers don't cover sex-reassignment surgery, the state Insurance Commissioner's Office says.

Dr. Marci Bowers, a prominent gender-reassignment surgeon in Colorado, said nearly all of the people she sees pay out of pocket. Only a tiny fraction of her patients are on Medicaid, she said, and most of those need some sort of court order to get coverage.

It's unclear how many states provide coverage through their health plans for the poor. California does. But New York prohibits using state money for any gender-reassignment treatments, including hormone therapy and surgery.

Washington's new "evidence-based" approach, which denies coverage for surgery but allows less-costly treatments, is modeled after a similar policy in Iowa that has been upheld in federal court.

Dr. Jeff Thompson, medical director for Washington's Medicaid agency, said he thinks that barring any treatment for gender dysphoria might violate federal Medicaid law, which prohibits states from discriminating on the basis of a particular illness.

The U.S. Internal Revenue Service used to allow tax deductions for sex-change medical expenses. But that practice was stopped earlier this year after some two dozen members of Congress sent a letter to the IRS calling it "an outrage."

— Ralph Thomas