Group health plan sponsors, third-party administrators and other health plan service providers must navigate a shifting legal landscape as they determine how to offer gender-affirming benefits, including whether − and to what extent − group health plans must cover gender-affirming medical or surgical treatments, especially regarding minors. In this On the Subject, we discuss recent legal developments impacting gender-affirming care and approaches to group health plan coverage.
California Governor Gavin Newsom recently signed Assembly Bill 352 and Assembly Bill 254 into law, effective January 1, 2024. Through these new laws, California seeks to mitigate the risk of out-of-state prosecution of individuals seeking abortions or gender-affirming care. These bills include significant changes to California privacy and health information interoperability laws that will impact healthcare providers, health plans, employers, electronic health record developers and certain digital health companies handling medical information related to gender-affirming care, abortion, and abortion-related services, sexual health, fertility or contraception.
The US Circuit Court of Appeals for the Fourth Circuit recently heard two cases from North Carolina and West Virginia state-run health plans that challenge lower court decisions on coverage exclusions for gender dysphoria treatments. According to this Law360 article, the cases could determine how much health plans can restrict access to gender-affirming care. McDermott Partner Sarah Raaii said employers are investigating how to preserve gender-affirming care access in places where it might no longer be accessible.
“I think a lot of the conversation is also coming back to travel benefits,” Raaii said.
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