Maryland to Cover Gender Reassignment Procedures for State Employees

Maryland has dropped its exclusion from coverage for sexual identification transition-related care from all health plans for state employees and has replaced it with a gender dysphoria benefit. Maryland becomes the third state to provide coverage for sex-transition related health care, joining Oregon and California, which began providing coverage in 2013 and 2014 respectively. The change in Maryland became effective on July 1, 2014, according to a report in the Baltimore Sun, but was not publicly announced until July 22, 2014.

The change was the result of a legal claim made by Sailor Holobaugh who was denied coverage for a medically necessary bilateral mastectomy. Mr. Holobaugh is a clinical research assistant in neurology at the University of Maryland School of Medicine in Baltimore. In November of 2012, Mr. Holobaugh paid $6,000 for the surgery out of his own pocket. He sought reimbursement by making a claim through the State of Maryland Employee and Retiree Health and Welfare Benefit plan. The claim was denied based on an exclusion in the plan for “any procedure or treatment designed to alter an individual’s physical characteristics to those of the opposite sex,” according to a press release from FreeState Legal who represented Mr. Holobaugh in legal actions on this issue. Mr. Holobaugh argued that this exclusion violated Maryland’s Governor Martin O’Malley’s (Dem.) 2007 executive order prohibiting discrimination in state employment on the basis of gender identity. Maryland agreed to reimburse Mr. Holobaugh for his surgery and other transition-related medical costs to date and apply the new gender dysphoria benefit to all of its employee health plans instead of fighting Mr. Holobaugh’s claim in court.

Gender Dysphoria Benefit

The new gender dysphoria benefit covers treatments that are medically necessary and includes coverage of hormone replacement therapy, a variety of surgical procedures, and other transition related care options. The standard for medical necessity under the benefit closely tracks the standards of care established by the World Professional Association for Transgender Health, which is internationally recognized as the leading authority on health care for transgender persons according to FreeState Legal. The benefit applies to all state employees and retirees as well as their spouse and dependents.

“I am thrilled that people who serve Maryland as state employees now have increased access to health services, and that they can extend these benefits to their dependents,” said Holobaugh. Jer Welter, Managing Attorney for FreeState Legal, however, noted that “there is still work to be done, including the elimination of similar transition-related care exclusions in the Maryland Medical Assistance (Medicaid) program and in policies issued by private insurers regulated by the Maryland Insurance Administration.” FreeState Legal is a legal advocacy organization that seeks to improve the lives of low-income lesbian, gay, bisexual, transgender and queer Marylanders.