Insurance Coverage for Medically Necessary Health Care
Jasmine Glenn and Jamie O’Brien are transgender women who have insurance coverage through Michigan’s Medicaid program, which contracts with private insurance companies, Priority Health and Meridian Health, to provide Medicaid services. As a result of the non-discrimination provisions of the Affordable Care Act, also known as Obamacare, both insurance companies initially approved coverage for vaginoplasty surgery, agreeing with Ms. Glenn and Ms. O’Brien’s medical providers that this procedure was medically necessary.
However, due to delays in scheduling the surgery, requests for pre-authorization of the surgical procedure had to be resubmitted. Priority and Meridian have now reversed course and are denying coverage for the procedure, not disputing its medical necessity, but pointing to new policies that now have blanket exclusions for gender confirmation surgeries for transgender beneficiaries.
The ACLU of Michigan filed internal appeals with the insurance companies, which upheld the initial denials. We then filed for external review with the Department of Insurance and Financial Services (DIFS), the state insurance regulatory agency. DIFS upheld these denials in August 2018, and we are now seeking judicial review in the Kent County and Monroe County Circuit Courts.
(Glenn v. Department of Insurance & Financial Services; O’Brien v. Department of Insurance & Financial Services; ACLU Attorney Jay Kaplan.)