Gender Justice League is excited to announce our Frequently Asked Questions document on the Washington Apple Health Plan's Transgender Health Coverage.
The Washington Healthcare Authority announced on Friday July 31st that it has issued it's final rules for expanding coverage for gender transition related health care. The new rules go further than any other state so far, covering additional medically necessary procedures and providing parity of coverage with other medical and mental health conditions. The new rules also provide a clear and concise policy for appeals of currently "non-covered services" that may be medically necessary on a case by case basis for individual transgender people.
Gender Justice League extends our thanks and congratulations to our many colleagues in the Coalition for Inclusive Healthcare in this victory - with special thanks to Lisa Brodoff of Seattle Unviersity School of Law (whose lawsuit on behalf of a client initiated this process nearly 6 years ago!), Marsha Botzer of Ingersoll Gender Center, David Ward of Legal Voice, Kris Hermans of Pride Foundation, Jenni Wong of the ACLU of Washington, Monisha Harrell of Equal Rights Washington, Tobi Hill-Mayer of Gender Justice League, Gunner Scott of Pride Foundation, Seth Kirby of Oasis Youth Center, Petra Wilson, the many other Coalition members, as well as the dozens of trans people, advocates, medical and mental health providers, parents, and supporters who provided public testimony to the Healthcare Authority.
"This is an astounding victory that took nearly 5 years to achieve," said Danni Askini Gender Justice League's Executive Director "We are so greatful to have been a part of this collaborative advocacy effort and look forward to ensuring a smooth implementation of this new policy. While we know not all surgical services will be immediately available in Washington State, we are working closely with the Health Care Authority to identify and contract with surgical providers. This is a huge step forward but we have a great deal of work to do to ensure that all trans and gender non-conforming Washingtonians get the medical and mental health care they need"
The new policy goes into effect August 31st and will cover all medically necessary mental health, medical, and surgical services listed bellow.
Please see our very detailed Frequently Asked Questions document to understand the details of this new and exciting policy.
Additionally you can read the source documentation from the Health Care Authority of Washington (who issues rules on Apple Health) including, The HCAs Answers to Our Testimony, Their Guidance to Physicians, and of course The Final Rule Document.
Bellow are the list of covered services:
(if deemed medically necessary for you by Apple Health)
Please note this list is not exhaustive. The following list is a treatments that may be considered medically necessary for some people. It also notes the availability of these treatments in Washington to the best of our knowledge.
|Treatment||Description or example||Is it available in Washington?|
|Hormone therapy||Prescription testosterones, estrogens, progesterone, etc.||Yes. You just need a prescription and to go to a pharmacy that takes your health insurance. You will also need to get a diagnosis of gender dysphoria from a licensed mental health provider and a prescription from your primary care doctor or a specialist.|
|Puberty blockers||Suppressants that act as a “pause button” on the body’s release of hormones typically begins at puberty|
|Hormone blockers||Aromatase inhibitors or gonadotropin-releasing hormone (GnRH) analogues used to suppress hormone release (ex. Anti-androgen, androgen blocker)|
|Mental health treatment||Counseling, psychotherapy, substance abuse treatment, family or couples counseling, and crisis intervention treatment.||Yes. You just need to find a therapist,
substance abuse treatment center, or crisis intervention center who takes Apple Health. Contact your Managed Care Organization for more details
|Preventive screenings||Pap tests, prostate exams, mammograms, breast exams||Yes. You need to go to a provider who takes Apple Health. Please know they no longer can deny you care that does not correspond with your gender marker in your file.|
|Laboratory tests||Blood tests to assess
hormone levels, electrolytes, cholesterol levels, liver or kidney
|Yes, as long as your labs are ordered by a doctor who takes your insurance and sends you to a lab that is covered by your insurance.|
|Hysterectomy; Salpingo-oophorectomy||Removal of the uterus,
cervix, fallopian tubes and ovaries
|Many doctors are experienced at these surgeries for non-transgender people but may not have treated trans patients. They should be readily available in Washington, however be careful in selecting your surgeon.|
|Orchiectomy||Removal of testicles||Yes, there are providers at University of Washington Urology Department who have performed these surgeries. You will want to verify they are taking your Managed Care Organization.|
|Removal of the chest or breast tissue for transgender men – Chest Reconstruction or top surgery||Chest surgery is available in Washington State – we are working to identify surgeons who will take Apple Health. It is important to note that while currently chest surgery for trans people is labeled under mastectomy, it is a different procedure than a standard mastectomy received for breast cancer and should be done by a surgeon that is familiar with chest reconstruction for trans people.|
|Breast Reconstruction /
|Adding a saline or silicone filled medical device to your chest to reconstruct your chest or breasts to be larger.||Breast Reconstruction is readily available in Washington State – we are working to identify providers who are willing to take Apple Health. Several surgical providers such as the Poly Clinic, Swedish Medical Center, and University of Washington Medical Center may be good places to inquire about these services as they generally take Apple Health. These providers will have to sign up with Apple Health first as a COE provider.|
|Laryngoplasty||We believe this means vocal chord surgery – or voice modification surgery||We are unsure if this service is available in Washington State – please contact Apple Health’s Transgender Health program for more information.|
|Abdominoplasty||Removing excess skin or fat from the abdomen which may be needed for other surgical procedures such as bottom surgery.||Abdominoplasty is readily available in Washington State, however – this procedure is likely only covered when done in combination with another medical procedure. You should check with the surgeon you are working with for bottom surgery to find out more. Some surgeons may want to do the surgery themselves, and having a separate surgeon in Washington do this surgery may not be helpful.|
|Belpharoplasty||Surgical treatment of the eyelid||This surgical procedure is available in Washington State and may be medically necessary as a component of facial feminization surgery. Please consult with your primary care doctor, mental health team, and a surgeon to determine medical necessity.|
|Colpecotmy; Vaginectomy||Surgical removal of the vagina||This procedure is typically done in conjunction with other bottom surgeries. It may be available in Washington, we are currently unsure. However, if you plan to have other bottom surgeries you should consult the bottom surgeon first before doing this procedure locally.|
rerouting of the urethra
|We aren’t sure when these surgeries will be available in Washington. Right now we do not know of any local doctors who provide these and accept insurance. However, you should contact the Healthcare Authority – covered services should be made available to all patient, Apple Health can coordinate this care.|
reconstruction of the penis
|Scrotoplasty; Placement of testicular prosthesis||The creation of the scrotum; implantation of testicular implants/prosthesis.||This procedure is not likely available in Washington State.|
|Genital electrolysis||Electrolysis done in preparation for Vaginoplasty.||Most surgeons require patients to undergo genital electrolysis prior to vaginoplasty. This is considered a medically necessary service when done in conjunction with preparation for vaginoplasty – it is important to note that this must be done in a physician’s office to be covered by Apple Health. This procedure is available in Washington State.|
|Vaginoplasty, Penectomy, Cliteroplasty, Colovaginoplasty, Labiaplasty ,Genital surgery.||Construction or
reconstruction of the vagina, removal of the penis, creation of the labia, and creation of the clitoris.
|We aren’t sure when these surgeries will be available in Washington. Right now we do not know of any local doctors who provide these and accept insurance. However, you should contact Apple Health who is working to identify a contract surgeon out of state.|
(only considered on a case-by-case basis under Exception To The Rule)
Please note this list is not exhaustive. The following list is a treatments that may be considered medically necessary for some people but only on a case by case basis through the "Exception to the Rule process" Please read our FAQ for more information on this process. Please remember: these are not generally covered – and you must first BE DENIED these services, and then file an appeal including the documentation outlined in the FAQ justifying the medical necessity of these procedures. It also notes the availability of these treatments in Washington to the best of our knowledge.
|Treatment||Description or example||Is it available in Washington?|
|Brow lift||A surgical procedure to shorten the length of the forehead / brow.||Yes|
|Calf implants||Prosthetic implants to increase the size/definition of the calf muscle.||Possibly, we are unsure.|
|Cheek/Mylar implants||A surgical procedure to place a prosthetic that increases the size or prominence of the cheeks.||Yes.|
|Chin/nose implants||A surgical procedure to place a prosthetic that increases the size or prominence of the chin or nose.||Yes.|
|Collagen injections||Injections of the face to increase prominence or feminize the face.||Yes.|
|Drugs for hair loss or growth||Drugs that are specifically used for hair growth.||Yes, despite this - we believe that these medications may be covered under testosterone suppression/hormone blockade. Check with your primary care provider.|
|Facial or trunk electrolysis||Removal of body or facial hair by electrolysis.||Yes, this is widely available in Washington.|
|Facial feminization||Surgical procedures to feminize the face||Yes, there are several Washington plastic surgeons who perform surgeries to feminize the face|
|Face lift||A surgical procedure to ”rejuvenate” the face or reduce the appearance of age||Yes, this is widely available in Washington.|
|Forehead lift||A reduction of the forehead to shorten it and bring the hairline downward.||Yes, we believe this is available in Washington State.|
|Hair transplantation||Transfer of hair follicles from one part of the scalp to another part.||Yes, this is widely available.|
|Jaw shortening||A procedure to shorten the length of the jaw.||Yes, there are Maxilliofacial surgeons in Washington performing this procedure.|
|Lip reduction||A surgical procedure to reduce the size or prominence of the lips or reduce the size the surrounding skin.||Yes, this procedure is available.|
|Liposuction||The surgical removal of fat by a suction assisted device.||This is widely available in Washington|
|Mastopexy;||Also called a ”breast lift” this procedure raises the areola and breast tissue on the chest.||Yes, this procedure is widely available in Washington|
|Neck tightening||A surgical procedure to tighten the skin of the neck.||Yes, this is available in Washington.|
|Pectoral implants;||The implantation of devices intended to increase the prominence of the pectorals muscles.||This procedure is available in Washington|
|Reduction thyroid chondroplasty; Trachea shave||Surgical procedures to reduce the prominence of the Adams Apple / Trachea protrusion.||Yes, this procedure is available in Washington|
|Removal of redundant skin||Surgical procedures to reduce excess skin.||These surgeries may be available in Washington.|
|Suction-assisted lipoplasty of the waist||A form of Liposuction of the waste||Yes, this is available in Washington|
|Voice modification surgery; Voice Therapy||Surgical procedures to change the pitch, tone, or resonance of the voice.||We are unsure, these surgeries may be available. Note: Larygoplasty is a covered service – we are currently unclear about this contradiction.|
“The agency evaluates a request for any non-covered service listed in (e) of this subsection as an exception to rule under the provisions of WAC 182-501-0160. The justification included in the surgical plan for any of the procedures listed in (e) of this subsection may be recognized by the agency as meeting the documentation requirements of WAC 182-501-0160”
Gender Justice League congratulates the Seattle City Council for unanimously passing legislation transmitted to the council by Seattle Mayor Ed Murray. Seattle joins West Hollywood, California and Washington DC in requiring all single stall restrooms to be labeled as gender neutral. This legislation specifically will increase access to safe restrooms and public accomodations for transgender and gender non-conforming residents and visitors in Seattle. The legislation is part of a set of comprehensive recommendations made by the Mayor's Task Force on LGBTQIA Hate Crimes and the Mayor's Action Plan. The policy was also proposed by both the city's LGBTQ Commission and former city council member Sally Clark, we are honored to support their work!
Mayor Murray's office said today: "This legislation will provide for all-gender restroom facilities and amend the Seattle Municipal Code so that single-occupant restrooms will no longer be restricted to a specific sex or gender identity. Single-occupant restrooms in City facilities and all public accommodations (including restaurants, coffee shops, stores, etc.) must have signage that makes it clear that they are not gender exclusive and allow use by any person regardless of sex or gender identity, rather than just “men” or “women.” The Seattle Office of Civil Rights (SOCR) will be responsible for enforcing these changes." You can read his office's full comments on their website.
Gender Justice League joined the work of the Seattle LGBTQ Commission over the last 3 years in supporting this legislation - you can read our letter of support to the council committee when the legislation was first introduced this spring. Many LGBTQ organizations joined in the call for this legislation, specifically citing the horrifying statistic that 53% of transgender and gender non-conforming people have faced verbal harassment or disrespect in places of public accommodations, and 8% had reported being physically attacked or assaulted in places of public accommodation.
Gender Justice League has recently partnered with Pike Place Market to change the labeling of their bathrooms (the oldest public bathrooms on the west coast), as well as with local artists and designers to create more gender neutral rest room signage to assist places of public accommodation in following this ordinance. Gender Justice League looks forward to working with the Seattle Office of Civil Rights and the Seattle LGBTQ Commission in providing guidance and assistance to local area businesses in following these new guidelines.
For more information or press inquiries - please contact our Executive Director - Danni Askini, [email protected]
Gender Justice League has announced the award recipients for the 1st annual Gender Justice Awards. The 11 award recipients and categories are as follows:
Gender Justice Awards and Honorees
The Emergence Award honors Selam Abunu, an emerging activist within the trans community, to elevate their work and encourage ongoing community support for their future work. The Emergence Award is honored with a $500 grant. Selam currently works at Peace on the Streets by Kids from the Streets (PSKS) helping unhoused LGBTQIA+ youth find stability and community. Selam has contributed a great deal to the conversation and work in the community to address the issue of homelessness facing LGBTQIA+ youth.
The 2015 Gender Justice Awards dinner will highlight and showcase the incredible activism of Trans and Allied Activists who have made incredible strides for Trans, Gender Queer, and Gender Non-Conforming people in the Pacific Northwest.
This year's Gender Justice Awards will be hosted by Ian Harvie comedian and actor who appeared in the Golden Globe Award winning series Transparent.
Tickets Available at: BROWN PAPER TICKETS
Doors Open: 6pm
Dinner & Program Starts: 7pm
Event Ends: 10pm
We will join together to celebrate Trans activist, performers, community members and allies working in a number of key areas:
Emerging Activist Award
HIV/AIDS Justice Award
Organization, Group, or Business Award
Health Justice Award
Public Official or Political Power Award
Artist, Writer, or Performer Award
Longevity & Self Care Award
Tickets costs are going to:
Price of a catered Meal
Emcee & performers
Our Views on ethical fundraising:
We ask attendees to come prepared to make an additional donation if possible, tickets are priced to be as accessible as possible for our community and are intended to cover just the cost of the event (catered food is expensive!). We recognize not everyone who attends can give, at our ticket prices we expect to only "break even". Additional Gifts will go directly to Trans* Pride Seattle 2015 and Gender Justice League's Education & Advocacy efforts.
Gender Justice League is committed to economic accessibility: 10% of seats (20) will be reserved for sliding scale attendance. Please email [email protected] if you are in need of a sliding scale ticket. Attendees can also sponsor one of these tickets.
Accessibility: GJL strives to make our spaces radically accessible. Melrose Market is wheelchair accessible.
ASL Interpretation: ASL interpretation will be provided.
Alcohol and Substance Use Policy: Gender Justice League strives to make our events accessible to all portions of our community, including young people and those of us recovering from substance abuse. As such, Gender Justice League intentionally does not serve alcohol at our events. We believe that it is possible to embraces a sober environment without sacrificing the joy and celebration of this community event. Those people who use substances such as medical marijuana to treat pain or other conditions are welcome to do so discretely and in locations that are in accordance with state law.
Smoke-Free, Low-Scent Policy: In order to make the Gender Justice Awards a healthy, accessible place for everyone, we are enacting a smoke-free, low-scent policy.
Smoke and many scents aggravate a large number of health conditions including asthma, migraines, multiple chemical sensitivities and compromised immune systems. A lot of people are forced to choose between missing out on community events or getting headaches, dizziness, sore throats, nausea, rashes and a whole bunch of other negative reactions.
Were changing that and we need your help. Please don’t smoke in or around the entranceway to this event. If you do smoke, please take a few minutes to air out afterward, and wash your hands when you get back. There will be unscented soap in the bathrooms. Also, on the day of the event please refrain from using cologne, perfume, nail polish, and other products with strong artificial fragrances or chemical odors (please do wear any topical medicine you need in order to be healthy regardless of scent). If you are not sure if a scented product will pose a problem for some people, the safe bet is to refrain from using it for this one day.
We recognize that for a lot of people, going smoke-free and low-scent is a big change. We appreciate this. And the effort on your part is a way of showing love for our community. As trans, gender queer, and gender non-conforming people we need a safe, loving space to call our own. Thank you for helping us make that place a reality.
Fragrance-free and low-scent alternatives to heavily scented personal grooming products are available, and alternatives can be made from basic ingredients for far less than even discount, mainstream products. For more information on fragrance-free and low-scent alternatives see here and here.
If you have any accessibility needs please contact Jessica Littenberg at [email protected]
Gender Justice League was honored to join with Councilmember Kshama Sawant's office and 10 other LGBTQ and allied community organizations to hold a community forum on hate violence in Capitol Hill. Since the start of 2015 - 8 trans women, 7 of them trans women of color have been murdered in the United States. 2014 saw a rash of hate violence on capitol hill including an attempted arson at Neighbors night club and the murder of two young black men in Leschi - though the crime started on Capitol Hill. Numerous GJL members have expressed an ongoing fear of violence and lack of safety on the hill and a desire to create community based solutions. We heard loud and clear from the community on Tuesday night - Hate Violence is a significant problem on the hill. Community members called for concrete actions to addressing income inequality, the housing affordability crisis, LGBTQ youth homelessness, and to restore funding for mental health and human services. Many community members shared their horrifying experiences of violence on the hill, and we were exceptionally thankful for their courage to educate. Calls for more housing for homeless LGBTQ youth resonated loudly in the room.
For our next steps - Gender Justice League will work with our community partners to bring together a Task Force to more closely coordinate our response to victims, clarify what community based solutions we believe will bring about progress in reducing hate violence on the hill, and make recommendations to public officials about how the city, county, and state can better respond to hate violence. What is clear is that Tuesday night's forum was the first step in an ongoing conversation about ways to address safety, livability, and hate violence in Capitol Hill. We look forward to working with community members, elected officials, and organizations to making tangible progress in reducing hate violence on the hill.
Gender Justice League has joined with our colleagues at Sex Workers Outreach Project - Seattle in expressing serious concerns about the impact of two new proposed anti-prostitution bills in Washington state that would dramatically increase penalties for "soliciting a prostitute". Senate Bills 5277 and 5048 would change sentences for conviction from up to 90 days in jail and a $1,000 fine to 1-year in jail and a $5,000 fine along with civil forfeiture for any property used "in the commission of soliciting a prostitute" - this could include a home, computer, vehicle, cell phone, or other property. These bills will deeply impact transgender people, 16% of whom have engaged in sex work at some point by creating unsafe conditions in Washington.
More than 10 Gender Justice League and Sex Workers Outreach Project members attended a hearing on Thursday January 22nd on the Bill - but were not allowed by the committee to provide testimony. Gender Justice League has provided written testimony to the committee and the bills sponsor Sen. Kohl-Welles (D) - Ballard/Magnolia/Queen Anne.
Gender Justice League's position is consistent with that of the World Health Organization, Amnesty International, Human Rights Watch, UN AIDS, UN WOmen, The Canadian HIV/AIDS Legal Network, Open Society Foundation, The UN Special Repporteur on the Right to Health, the UN Global Commission on HIV and the Law, and the American Civil Liberties Union of Washington which is that these bills would create unsafe working conditions for sex workers, do little to impact the problem of human trafficking for prostitution, and increase the spread of HIV. You can download our full testimony. Or read it bellow!
We are seeking organizational sponsors who agree with our position to sign onto our letter to legislators. Please contact Danni Askini, Executive Director through our contact us page.