Washington state requires insurers to cover gender-affirming care starting Jan. 1

New law prohibits health insurers from denying or limiting coverage for gender-affirming treatment.

Updated: December 30, 2021 - 11:16pm

Dozens of new laws go into effect in 2022 in Washington. One that hasn’t gotten as much attention as new taxes or a minimum wage hike is a rule to protect gender-affirming medical treatment.

Senate Bill 5313, passed by the legislature and signed by Gov. Jay Inslee earlier this year, prohibits health insurers from denying or limiting coverage for gender-affirming treatment provided that it is consistent with a protected gender expression or identity, is medically necessary, and is prescribed under accepted standards of care. The Gender Affirming Treatment Act takes effect on Jan. 1.

“While the clarifications in the rule seem technical, the implications for transgender and gender-diverse people is significant,” said Insurance Commissioner Mike Kreidler in a Dec. 28 press release. “Advocates told us over and over again that gender-affirming treatment saves lives. As the insurance regulator, I take seriously my duty to make sure laws and rules around insurance coverage are as inclusive as we intend them to be and insurers aren’t able to issue blanket denials based on inadvertent loopholes in the law.”

The law forbids insurers from applying categorial cosmetic or blanket exclusions to gender-affirming treatment. Many health plans in Washington state classify gender confirmation treatment as cosmetic, meaning such treatment is often not included in health insurance plans.

The law also requires that a health care provider with experience in gender-affirming treatment review and confirm the appropriateness of any denial of or limited access to gender-affirming services.

As of Jan. 1, 2020, minors age 13 and older aren’t required to notify their parents when seeking gender-affirming services. California and Oregon have similar laws, while other states have banned the practice on minors.

Following the recent urging of the American Medical Association (AMA) to provide minors with gender-affirming care, the law includes no age restrictions.

“Our rule deals only with the insurance coverage of gender-affirming medical treatment, not parental consent,” Stephanie Marquis, media and outreach manager for the Washington State Office of the Insurance Commissioner, said in an email response to a question about any possible conflict between parental rights and gender-affirming treatment for minors. “Generally, the age of consent for medical treatment is 18, but there are laws in Washington state that allow minors to consent to treatment in certain situations.”

Marquis then referred to a link to a “dated” 2006 document summarizing health care services that can be provided to minors without parental consent.

Per a 2019 AMA issue brief:

Members of the transgender community are three times more likely to be diagnosed with mental health disorders.Individuals with gender dysphoria who have undergone no gender confirmation treatment are twice as likely to experience moderate-to-severe depression and four times likely to experience anxiety compared to their surgically-affirmed peers.Suicide rates drop from 30% for pre-treatment transgender people to 8% who are post-treatment.