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The Vermont Federation of Nurses and Health Professionals and a coalition of community organizations have successfully removed health insurance barriers for the state's transgender community.

"Because of our leadership, the Vermont Department of Financial Regulation issued a bulletin that instructs insurance companies to provide medically necessary care, regardless of gender identity," says VFNHP president Mari Cordes.

Vermont becomes the fourth state where insurance regulators have issued bulletins clarifying that their state laws prohibit insurance discrimination against transgender people. The other states are California, Colorado and Oregon, in addition to the District of Columbia.

The VFNHP launched a campaign to end healthcare insurance exclusions against transgender people when a member approached Cordes and told her that Fletcher Allen Health Care banned transition-related care in its insurance plans.

"It was heartbreaking to me," Cordes says, "that this kind of discrimination could exist in Vermont in 2012."

But according to the Center for American Progress, "most private insurance plans, as well as many state Medicaid programs, incorporate plan language that specifically targets transgender people by excluding, for example, all services related to sexual

reassignment; any treatment or procedure designed to alter an individual's physical characteristics to those of the opposite sex; care, services or treatment for ... gender dysphoria or sexual reassignment or change ... including medications, implants, hormone therapy, surgery, medical or psychiatric treatment."

The center notes that "these exclusions are based on the false premise that the halthcare services that transgender people need are not medically necessary and are never needed by non-transgender people." However, the services denied to transgender people, such as mental health, hormone therapy and reconstructive surgery, are needed by non-transgender people.

As a part of its campaign, Cordes and other VFNHP members formed the Equal Care Coalition, which included advocacy organizations like Outright Vermont, RU12 and Vermont CARES. The coalition also had the backing of the state's governor as well as other state officials and lawmakers.

The coalition took several different approaches to reach its goal of stopping transgender healthcare discrimination. The VFNHP member who contacted Cordes, with guidance from the Equal Care Coalition, started by meeting with Fletcher Allen management to discuss getting the exclusion removed. Next, the coalition worked with state lawmakers to introduce legislation that would clearly define discrimination based on gender identity and prohibit it. Cordes and other VFNHP members also testified before lawmakers to educate them about gender identity discrimination and its impact on the transgender community.

"We let lawmakers know that insurance companies shouldn't be making decisions about care, " Cordes says "That's something that should be up to the healthcare provider team, with the patient."

Finally, the coalition worked with the commissioner of the Vermont Department of Financial Regulation to push for a bulletin to clarify that the state prohibits insurance discrimination. Although the state General Assembly had passed a law in 2007 to prohibit discrimination on the basis of gender identity, insurance companies were able to get around the law by not covering transition-related care.

The nurses and the coalition didn't know which approach would pay off. Time was running out in the Legislature, and they didn't know if the Department of Financial Regulation would issue a bulletin. "It was a nail biter," says Cordes.

Ultimately, the Department of Financial Regulation issued its bulletin saying that isurance companies could not exclude coverage for medically necessary treatment, including gender reassignment surgery . The bulletin went into effect in April. In the end, Cordes says, the state did the right thing by removing the exclusion from its insurance. [Adrienne Coles]

June 6, 2013