Minnesota Dept. of Human Services adds Medicaid drug coverage for transgender teens

Transgender teens on the Minnesota Medicaid program are now eligible for transition-related medications that had been routinely denied for years.

Doctors who care for transgender youth say the change will make a big difference because it will give them more options as they progress toward adulthood. "Treatment delay has put adolescents at risk," said Dr. Kelsey Leonardsmith of Family Tree Clinic in St. Paul. "I've been pleased with our ability to get these vital lifesaving medications."

The change in policy by the Minnesota Department of Human Services (DHS) also extends to the MinnesotaCare insurance program. While doctors and transgender health care advocates applaud the decision, they say that some private insurance plans are still denying the needed medications or making it difficult to get them. "I have seen outright denials where no amount of advocacy makes a difference," said Leonardsmith.

About 3% of Minnesota high schoolers identify as gender diverse, meaning that their gender identity differs from their sex assigned at birth. It also could mean that they are in flux or consider themselves neither exclusively male or female.

The new Medicaid policy, which took effect in August, allows doctors to prescribe hormones, such as testosterone, for those who have decided to transition.

It also provides coverage for puberty blockers, which prevent the physical progression of puberty.

"These medications basically are a pause button so that patients can work with their therapists and doctors in order to come to better terms with their gender and then make a more adult decision about how to proceed with their puberty progression when the time comes," said Dr. Christopher Dunne, an endocrinologist at the gender health program at Children's Minnesota.

"Going through puberty of the wrong sex can be very distressing for adolescents who are transgender," said Dunne. "Puberty is hard enough already, and then if you add being transgender on top of that it is even more distressing."

While the medications either create or inhibit physical changes, those outcomes are fully reversible in cases where teens decide to stop taking the drugs.

Leonardsmith said that transgender teens who are denied access to medications they need sometimes isolate themselves from others.

"Some kids choose to go to online school," said Leonardsmith. "Or they stop participating in school activities because they feel as though their bodies won't let them participate in a way that is acceptable to them."

Lack of access to medications also increases the risk of suicide and mental health problems.

However, transgender youth and their families have more access to support networks than years ago.

"They are building these incredible spaces to provide support to each other," said Leonardsmith. "There is a ton of advocacy and support. It makes a difference in their lives."

The state human services department, which runs the Medicaid and MinnesotaCare programs, has several requirements before the medications can be provided to transgender teens.

Those include an assessment by a mental health professional as well as approval by a parent or guardian. Most insurers have similar prerequisites. Medicaid programs nationwide are required to pay for medications that are recognized as the standard of care by the Food and Drug Administration or certain national organizations that compile evidence-based treatment standards.

The treatments for transgender adolescents were recognized as accepted practice earlier this year.

"We brought it to DHS' attention and asked them to take whatever steps necessary to operationalize that," said Phil Duran, director of advocacy, research and education at JustUs Health.

The medications are "a pretty standard, broadly recognized therapy for trans kids, but thus far they haven't been eligible for coverage" on Medicaid or MinnesotaCare, he said. "This now opens up the doors in these public programs."

Dunne said he had been trying to get DHS to make the policy change for four years.

"Everybody that I talked to said that nothing can be done," said Dunne. "This policy change in Medicaid is now bringing Minnesota in line with other states that have made this change."

Glenn Howatt • 612-673-7192 Twitter: @GlennHowatt