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Top Hospital Pushing To Expand Medicaid Coverage To Trans Cosmetic Surgeries It Performs

  Johns Hopkins Medicine (JHM) is lobbying Maryland to extend Medicaid coverage to transgender cosmetic procedures, which could financially ...

 Johns Hopkins Medicine (JHM) is lobbying Maryland to extend Medicaid coverage to transgender cosmetic procedures, which could financially benefit the university hospital system.

Maryland’s Trans Health Equality Act would allow Medicaid to cover a variety of transgender procedures typically considered cosmetic, including changes to the voice, hair, face and neck and laser treatment for transgender surgical scars, as well as fertility preservation. Johns Hopkins leaders will give oral testimony to state legislators in support of the bill, in addition to JHM’s written testimony, according to a staff email previously published by journalist Andy Ngo; Johns Hopkins advocated for a similar bill in 2022.

“If enacted, the law would expand the types of medically necessary gender-affirming treatments that will be covered by Maryland Medicaid MCOs to include, inter alia, hair removal, body contouring, facial gender surgery, tracheal shave, vocal surgery, speech pathology, and fertility preservation,” the email read. “Additionally, the law would ensure that gender-diverse people, such as those who identify as nonbinary, intersex, or two-spirit, are included in coverage.”

JHM performs many of these procedures, according to its website, and the institution is eligible to provide care through Medicaid, Maryland Children’s Health Program and Primary Adult Care. 

For males seeking a more feminine appearance, JHM offers nose surgery, brow and forehead lifts, chin, cheek and jaw reshaping, Adam’s apple reduction, lip augmentation, hairline restoration, earlobe reduction, laser hair removal, voice therapy, breast augmentation and vaginoplasty, according to its service listings. For females, JHM offers hairline reshaping, jaw augmentation, thyroid cartilage enhancement, hysterectomy, mastectomy and phalloplasty.

JHM worked with state legislators to draft very similar legislation in 2022, according to the bill sponsor’s testimony; this bill was also called the Trans Health Equity Act. Dr. Helene Hedian, director of clinical education at Johns Hopkins’ Center for Transgender Health, urged the legislature to pass the Trans Health Equity Act of 2022 in written testimony, and she is expected to give oral testimony to lawmakers in support of the bill’s new version later this month, according to the email from JHM.

“Hair removal and hair transplantation, speech therapy and voice surgery, facial feminization surgery, body contouring, and fertility preservation are all excluded from the current coverage. You might ask yourself – why are these procedures medically necessary? Especially given that patients may take hormones which are covered by their current plans,” Hedian wrote in her 2022 testimony.

Hormones cause significant changes to one’s appearance but do not alter bone structure, hair growth or voice, making them insufficient for some transgender patients, Hedian argued. Additionally, some transgender patients have medical reasons to avoid taking hormones and need to alter their physical appearance through other means.

“These procedures are not cosmetic. They are not elective,” she wrote. “There are people who will challenge, confront, and even assault a person who doesn’t appear to fit neatly into a category of ‘man’ or ‘woman.’ … The sad truth is that when people are not immediately identifiable as transgender by their appearance or the sound of their voice by a malicious stranger on the street, they are safer.”

“As a pragmatic observation from a healthcare provider: people who are happier in their bodies take better care of them. And people who take better care of their bodies have fewer healthcare expenses,” Hedian wrote.

JHM’s support for the bill tracks with a broader trend of experts in gender medicine advancing their financial interests and those of their institutions through advocacy, such as the American Society of Plastic Surgeons fighting against state legislation restricting child sex changes.

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