The Maryland Insurance Administration issued a bulletin on Jan. 27 indicating that insurance carriers cannot discriminate against transgender individuals in the state based on gender identity. The purpose of the bulletin was to clarify the scope of the exclusion in the benchmark plan selected to define essential health benefits in Maryland as required by the Affordable Care Act for “treatment leading to or in connection with transsexualism, or sex changes or modifications, including but not limited to surgery.”

In other words, insurers cannot discriminate against transgender individuals under a health benefit plan on the basis of the insured’s actual or perceived gender identity for ordinary medical care but “the exclusion should be narrowly applied to items and services that are directly related to the gender reassignment process.”

The announcement was questioned by some members of the LGBT community on social media. “So this says that it is OK to discriminate against a transgender person if their medical need is transitioning,” wrote one woman who identified as trans on Facebook. “That doesn’t mean just surgery, which is relatively costly, but also allows discrimination regarding hormone therapy, which is the cost of scribbling a script and the cost of hormones, which in some cases is as little as five dollars at Walmart or CVS. All this really says is that they can’t discriminate against a transperson who has, say, high blood pressure or diabetes.”

Equality Maryland responded, “The bulletin is a first step in clarifying that transgender people in Maryland must have access to coverage and the medically necessary care they need. Further steps must be taken to ensure that Maryland law extends full and equal access for transgender people to coverage and care, including coverage for transition-related procedures and any other services that are covered for non-transgender people.”