Jonnby S. LaGuardia MD, Madeline G. Chin MD, Sarah Fadich PA-C, MCHS, Katarina B. J. Morgan DDS, MPH2, Halena H. Ngo BA, Meiwand Bedar MD, MSc, Shahrzad Moghadam MD, Kelly X. Huang BS, Christy Mallory JD, Justine C. Lee MD, PhD, FACS
{"title":"性别确认手术的医疗补助覆盖范围：逐州审查。","authors":"Jonnby S. LaGuardia MD, Madeline G. Chin MD, Sarah Fadich PA-C, MCHS, Katarina B. J. Morgan DDS, MPH2, Halena H. Ngo BA, Meiwand Bedar MD, MSc, Shahrzad Moghadam MD, Kelly X. Huang BS, Christy Mallory JD, Justine C. Lee MD, PhD, FACS","doi":"10.1111/1475-6773.14338","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage.</p>\n </section>\n \n <section>\n \n <h3> Data Sources and Study Setting</h3>\n \n <p>Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals.</p>\n </section>\n \n <section>\n \n <h3> Study Design</h3>\n \n <p>A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries.</p>\n </section>\n \n <section>\n \n <h3> Data Collection/Extraction Methods</h3>\n \n <p>We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described.</p>\n </section>\n \n <section>\n \n <h3> Principal Findings</h3>\n \n <p>Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (<i>p</i> = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (<i>n</i> = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (<i>n</i> = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.</p>\n </section>\n </div>","PeriodicalId":55065,"journal":{"name":"Health Services Research","volume":"59 6","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622269/pdf/","citationCount":"0","resultStr":"{\"title\":\"Medicaid coverage for gender-affirming surgery: A state-by-state review\",\"authors\":\"Jonnby S. LaGuardia MD, Madeline G. Chin MD, Sarah Fadich PA-C, MCHS, Katarina B. J. Morgan DDS, MPH2, Halena H. Ngo BA, Meiwand Bedar MD, MSc, Shahrzad Moghadam MD, Kelly X. Huang BS, Christy Mallory JD, Justine C. Lee MD, PhD, FACS\",\"doi\":\"10.1111/1475-6773.14338\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Data Sources and Study Setting</h3>\\n \\n <p>Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Study Design</h3>\\n \\n <p>A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Data Collection/Extraction Methods</h3>\\n \\n <p>We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Principal Findings</h3>\\n \\n <p>Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (<i>p</i> = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (<i>n</i> = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (<i>n</i> = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.</p>\\n </section>\\n </div>\",\"PeriodicalId\":55065,\"journal\":{\"name\":\"Health Services Research\",\"volume\":\"59 6\",\"pages\":\"\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2024-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622269/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Services Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.14338\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Services Research","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.14338","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Medicaid coverage for gender-affirming surgery: A state-by-state review
Objective
To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage.
Data Sources and Study Setting
Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals.
Study Design
A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries.
Data Collection/Extraction Methods
We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described.
Principal Findings
Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (p = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (n = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (n = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate.
Conclusions
In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.
期刊介绍：
Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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