Gender Affirming Care
Current (2023) NYS LAW and Protections
Federal Law in many cases, the U.S. Constitution - prohibit discrimination in health care and insurance because you're transgender. That means that health plans aren’t allowed to exclude transition-related care, and health care providers are required to treat you with respect and according to your gender identity.
[https://transequality.org/know-your-rights/health-care]
Affordable Care Act, it is illegal for most health providers and organizations to discriminate against you because you are transgender. The following are examples of places and programs that may be covered by the law:
Physicians’ offices
Hospitals
Community health clinics
Drug rehabilitation programs
Rape crisis centers
Nursing homes and assisted living facilities
Health clinics in schools and universities
Medical residency programs
Home health providers
Veterans health centers
Health services in prison or detention facilities
New York law prohibits healthcare discrimination on the basis of transgender identity and, in 2021, all NYS insurance carriers were found to cover gender-affirming care.
In 2019, the Human Rights Law was amended through the Gender Expression Non-Discrimination Act (GENDA) to explicitly add gender identity or expression as a protected category. Discrimination on the basis of gender identity or expression is prohibited in all areas covered by the Human Rights Law.
Have you experienced this?
check out some of the examples- >
https://transequality.org/know-your-rights/health-care
Let Us Know
We track these events and submit to State Attorney General
Insurer calls you and states your services are not covered
Get the representative’s name, gain an Call back # ; request an written denial - then review your Explanation of Benefits ask to talk with an supervisor
options available to you: Peer to Peer consultation, appealing the decision ( it will freeze any movement 60 days to process)
That LMHCs are not able to provide the Letter : Not True
Get the representative’s name, gain an Call back # ; request an written denial - then review your Explanation of Benefits ask to talk with an supervisor. Ask your provider to reach out
options available to you: Peer to Peer consultation, appealing the decision ( it will freeze any movement 60 days to process)
Health plans can’t have a categorical exclusion of a specific transition-related procedure
Excluding from coverage specific medically necessary procedures that some transgender people need is discrimination. For example, a health plan should not categorically exclude all coverage for facial feminization surgery or impose arbitrary age limits that contradict medical standards of care.
Doctors office states you insurance doesn’t cover these services
Ask for an written documentation for this decision, Call your insurance directly and review the Explanation of Benefits, ask an trusted provider to aid you
A therapist states they cannot write a letter due to their certification status - not true
Per WPATH Standards of Care Version 7 and 8 (newest) : SoC7: pg. 28: “…. A master’s degree or its equivalent in a clinical behavioral science field. This degree or a more advanced one should be granted by an institution accredited by the appropriate national or regional accrediting board. The mental health professional should have documented credentials from a relevant licensing board or equivalent for that country. “
Breaking down systemic barriers of healthcare discrimination case by case.
What is REALLY Gender affirming care? Good question. Please do, ask this question. WE at Thriving Mental Health Counseling NY are harm-reduction Gender Affirming Consent-Inform based Therapists.
We recognize how much Gender and Sexual minorities, inclusive to Racial minorities healthcare accessibilities differ.
We acknowledge and witness, that there are systemic barriers to your healthcare rights. We have an social justice framework to unroot these practices.
We acknowledge WPATH SOC, and GALAP pledge.
We strive to devote annually each individual therapist 10 -ceus for Gender and Sexual minorities professional development.
Ryan Sforza, Practice director, as a Clinical Gender Therapist, I have over 70-credit hours devoted to this certification. And continuing to learn!
All therapists: provide gender affirmative intervention letters (surgery, HRT, ..), 2nd-ary for letters within 2-3 sessions*. * comprehensive cases may need more due to their insurance requirements. We also provide consultation for providers working with patients. Through the GALAP we all therapists participate.
Right in our own neighborhood…
Healthcare discrimination (gatekeeping) toward Gender and Sexual Minorities is real
All circumstances can be intentional on the part of the provider or misunderstood. When ever interacting with a provider, including ours, always ask these basic questions:
1) What constitutes as your experience with working of LGBQA, and TGNC folks? With terms of disability, privilege's, ethnicity, binary - to nonbinary
2) Do you offer gender affirming letters? All? if so, how many sessions do I have to complete to gain the letter? What happens if you cannot write the letter or its rejected?
3) Are you aware of WPATH Soc and GALAP project?
Below are a (some) examples of healthcare discrimination.
Providers tell a patient….
Informing a patient needing to demonstrate more stability, less severe symptoms, etc. till their gender affirming interventions can be sought after.
FACT: Chronic minority stress can eventually lead to the weakening of psychological coping strategies and produce poorer health outcomes (Gamarel, Laurenceau, Resiner, Nemoto, & Operario, 2014)
• After receiving Gender Non-Conforming care, patients/clients reported their psychological wellbeing increased to 78% while their suicidal ideation dropped 23.2% in their lifetime (Testa & Keo-Meier, 2015).
• “Clinicians should be aware that patients who have gender dysphoria (GD) often suffer from psychiatric comorbidities that worsen during puberty, at which time they are at high risk of suicide” (Lopez, X., Stewart, S., & Jacobseon-Dickman, E.,. 2016).
Providers tell a patient….
Need to gain more coping skills of their personality disorder first,.
FACT: WPATH SOCv.7 states: Part 3 “Ability to recognize and diagnose coexisting mental health concerns and to distinguish these from gender dysphoria (pp.22).
AMERICAN ASSOCIATION FOR PEDIATRICS SUGGEST:
• Recommends working from an Gender-Affirming-Care-Model (GACM) framework where “integration of medical, mental health, and social services, including specific resources and supports for parents and families.24 Providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender (Rafferty, 2018).
Providers tell a patient….
Telling the patient, the provider are ‘not qualified /specialized/’ to write / offer letters
FACT: Per WPATH and Master degree programs, any counselors with an Master’s degree in Counseling/ SW can write these letters.
WPATH SOCv.7 states: “The training of mental health professionals competent to work with gender dysphoric adults rests upon basic general clinical competence in the assessment, diagnosis, and treatment of mental health concerns….Clinical training may occur within any discipline that prepares mental health professionals for clinical practice, such as psychology, psychiatry, social work, mental health counseling, marriage and family therapy, nursing, or family medicine with specific training in behavioral health and counseling. (WPATH SOC.v7, pp22)”
Providers tell a patient….
Stating eventually you will provide the letter, when patient meets X,Y,Z. OR Telling the patient they need to be on HRT, or Id as XYZ
FACT: Gender dysphoria should be treated co-concurrently as research has proven: “When gender affirmation intervention treatment introduced Gender Dysphoria ‘was alleviated and psychological functioning had steadily improved.’[Psychological functioning was evaluated on several factors: (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness] well-being. (L.C. de Vries, McGuire, Steensma, Wagneraar, Doreleijers, & Cohen-Kettenis, 2014)”
Gender Affirming Care is….
Social transition
This includes from Hard documentation as:
Name change, gender markers, School / Employment guidance, etc.
To Soft items:
navigating the world, identity journey, increase in confidence, etc.
NYS courts of 2021 recognize that MH providers to offer gender markers and name change documents.
Medical Transition
This includes all: (hormones, surgical care, post-op secondary corrections, feminization / masculinization). We have been writing letters with ease to the most comprehensive cases since 2016. At this point, none of our letters are rejected. We have experience in gaining folks services. We will advocate for you. **Letters are only needed due to insurance companies mandating that patients who are pursuing treatment with gender dysphoria and to use health insurance.
Gender Identity/Expression Support / Exploration
Being Trans / Non-Binary, Gender expansive isn’t always about transitioning and we acknowledge that. For some folks calling your identity / body home may be a long process, or medical transition isn’t on your comfort list.
We serve all.
NYS Minor’s Healthcare rights:
NYS Mental Health Counseling and Services:
Consent: A minor’s 13 and up, right to receive mental health treatment without a parent’s consent depends on the type of treatment sought: outpatient treatment, where a minor is living at home and visits the mental health care provider for treatment only, or inpatient treatment, where a minor resides in the hospital or mental health care center.
Outpatient Treatment A minor who knowingly and voluntarily seeks mental health services can access treatment, including medication, without parental consent if any one of the following conditions applies:
• A parent or guardian is not reasonably available to consent; or • Parental involvement would be detrimental to the course of treatment; or
• The parent or guardian has refused to give consent and a physician determines that treatment is necessary and in the best interest of the minor; [165] If none of these circumstances apply, New York law requires the consent of a parent or guardian for outpatient mental health treatment [166]. A young person may meet with a mental health care provider without prior parental consent in order to determine whether the minor meets these guidelines [167]. Any determination as to whether the above criteria are met should be documented in the minor’s medical record
Confidentiality When a minor consents to mental health care, any information relating to treatment may not be disclosed without the minor’s permission. Even when a parent gives consent, the parent is not guaranteed access to information relating to the treatment. When a parent requests access to a minor’s mental health records, minors 13 and older may be notified of the request. If the minor objects to disclosure, the provider can choose to deny the parent’s request [176]. Further, professional ethics generally dictate that specific details of therapy sessions not be disclosed without the consent of the patient.
Alcohol and Substance Abuse Services
Consent: Although New York law generally mandates that steps be taken to involve parents in a minor’s substance abuse treatment, [181] a minor can receive non-medical alcohol or substance abuse services (such as counseling) without parental consent or notification.
NYS Mental Health Counseling and Services Law citations
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N.Y. Mental Hyg. Law § 33.21(c) (McKinney 2001); 14 N.Y.C.R.R. § 587.7(a) (3)(iii) (2001).
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N.Y. Mental Hyg. Law § 33.21(b), N.Y. Mental Hyg. Law § 33.21(a) (3), N.Y. Mental Hyg. Law § 33.03(b)(4) (McKinney 2001)
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N.Y. Mental Hyg. Law § 33.21(d) , . N.Y. Mental Hyg. Law § 33.21(c), Mental Hyg. Law § 33.21(e)(2) , N.Y. Mental Hyg. Law § 9.07(a) N.Y. Mental Hyg. Law § 9.09 , N.Y. Mental Hyg. Law § 9.13
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N.Y. Mental Hyg. Law § 9.13 (b) , N.Y. Pub. Health Law § 2504(4) , N.Y. Mental Hyg. Law § 33.16(c)(2), N.Y. Mental Hyg. Law § 33.16(b)(3) , American Psychiatric Association, Ethics Primer of the American Psychiatric Association 16-17 (2001), N.Y. Mental Hyg. Law §§ 33.23, 33.25, 45.07