Connecticut Commission Rules Transgender Health Care Exclusions Violate State Non-Discrimination Laws

The Connecticut Commission on Human Rights and Opportunities (the Commission) recently issued an important ruling condemning discrimination by state and municipal health insurance plans. On April 17th, the Commission ruled that provisions of such plans violate state non-discrimination laws in two specific scenarios involving gender affirming care. First, the Commission found provisions of such plans unlawful if they categorically exclude coverage for all gender affirming care. Second, the Commission likewise concluded that it is illegal for such plans to label services as medically necessary for certain conditions yet cosmetic for gender dysphoria. The Commission also ruled that insurers that sell or administer such plans with these kinds of provisions violate state non-discrimination laws. Representing the Connecticut TransAdvocacy Coalition as amicus, the Center for Health Law and Policy Innovation of Harvard Law School filed a brief to the Commission. 

The Commission’s declaratory ruling is a significant win for transgender and gender non-conforming individuals in Connecticut. Many health insurance plans sponsored by the State or offered by municipal governments contain discriminatory restrictions that block people from medically-appropriate gender affirming care. The plans span from those offered to municipal workers, including first responders, and to plans offered through public institutions of higher education, like the University of Connecticut. As noted in the ruling, more than 250,000 people (or approximately 7% of Connecticut’s total population) are considered State or municipal employees or students. Estimates suggest that more than 850 transgender people are covered by state or municipal plans that contain discriminatory exclusions.

The Commission’s ruling recognizes “[t]he treatment needs of transgender patients under generally accepted standards of care must be assessed on a case-by-case basis” and that “no standardized, one-size-fits-all treatment plan for gender dysphoria” exists. While insurers across the country have changed their plans to cover some gender affirming care, such as hormone therapy and genital surgeries, many continue categorical exclusions or “cosmetic” labeling of certain procedures used to address secondary sex characteristics, such as facial feminization or voice therapy. For some, these procedures can be of “greater practical significance in [a person’s] daily life” and medically necessary to address gender dysphoria. Blocking meaningful access to these procedures when used to treat gender dysphoria can cause transgender and gender non-conforming people to face continued misgendering and trauma, and ultimately subject them to inferior, discriminatory health care benefits.

Enforcement of state laws in this regard are vital to ensuring transgender and gender non-conforming people are treated fairly and that the State does not otherwise sanction discrimination on the basis of sex and gender identity. “Trans bodies are human bodies, and all human bodies

deserve to be treated with dignity and respect,” noted Dr. AJ Eckert, a board member of the Connecticut TransAdvocacy Coalition and owner of The Gender and Life-Affirming Medicine Center in Wethersfield, Connecticut. “Current health care coverage policies encourage invasive questionnaires, gatekeeping, and stigma, as it relates to the LGBTQ+ community. Providing non-discriminatory health care coverage is not only medically necessary, it is cost-effective and a step towards true equity.”

The Center for Health Law and Policy Innovation of Harvard Law School remains committed to promoting more equitable and effective health care systems, and we look forward to seeing insurers in Connecticut remove these restrictions from their plans in light of the Commission’s ruling.