My Book: The Conscious Parent’s Guide to Gender Identity

Many of you have probably been wondering why my blog has been so inactive lately. Well, I wrote a book! F + W Media, Inc. has a series called “The Conscious Parent’s Guide To…” about a number of different topics. They wanted to publish one on gender identity, found me through this blog, and asked me to write it! I was happy to have the opportunity to write about how to best support gender expansive kids to a more wide-reaching audience. I truly hope it helps a lot of families.

The book is ideal for parents/guardians of gender expansive kids, but could also be useful for extended family members, therapists, teachers; anyone involved in a gender expansive child’s life. Click here to order your copy: The Conscious Parent’s Guide to Gender Identity: A Mindful Approach to Embracing Your Child’s Authentic Self.

I do want to add that I did not write Chapter 1. Chapter 1 is the standard chapter for all of the Conscious Parent’s Guides. I only added in the parts related to gender. So, if you don’t love Chapter 1- keep going. 🙂 If you liked Chapter 1 best, sorry. 😉

In addition to the overview in Chapter 1 about conscious parenting, there are ways to incorporate being a mindful, conscious parent throughout the book. This is so much more than just being “present”, it’s about recognizing your little human as a separate being, with their own unique will and spirit. I write about how to best connect with your child in order to be most receptive to what they are trying to tell you.

I write about the differences between gender and sex, gender identity and sexual orientation, gender expression vs. gender identity, and what gender “expansiveness” really is. This not only helps those involved in a gender expansive child’s life understand these concepts, but helps explain them to others.

I discuss the concept of getting to know one’s child for who they are from the beginning, rather than making assumptions that later need to be shifted or undone. I write about parenting gender expansive children, and the difference between being transgender and “just” gender expansive. In the book you will find practical tips for interacting with and advocating for your gender expansive and/or transgender child, while learning how to trust yourself and appreciate life at the same time.

Later in the book there is more specific information for families who have a child in need of social or medical transition: how/when to navigate interventions, coping with outside influences/reactions, siblings, extended family, schools, etc. There is a specific chapter dedicated to “helping your gender expansive child with teasing”, based on the concepts I present at gender conferences. There is also a specific chapter dedicated to dysphoria, which is important for everyone involved in a transgender child’s life to understand.

The appendixes include some resources I hope you will find helpful, including ways of looking at natal sex/gender identity/gender expression/sexual orientation on spectrums, or on more of a fluid shape. There is a list of “Classroom Rules” to help classrooms promote diversity. There is also a worksheet for children who may need some help in understanding when a friend or loved one is going through transition. Last but not least, there is a sample letter from parents informing their loved ones about their child’s social transition.

Let me know how you like the book, and leave an honest review on Amazon! Thank you so much for your ongoing support of this blog, I promise to get back to writing regular posts soon.

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Kaiser’s New Policy In Response to DMHC’s Ruling

As I wrote about earlier, California’s Department of Managed Health Care (DMHC) has ordered California’s health plans to remove exclusions of coverage based on gender identity and expressionKaiser is the first I’ve seen to release more information about what they are specifically doing in response to these changes.

I couldn’t get my hands on an official document or website that outlines these changes, but I have been speaking with a couple of Kaiser representatives who have been answering my questions about the latest developments re: Kaiser and surgeries/treatments for transgender individuals. Part of this comes from an internal Kaiser document, so I did not post it in its entirety. If you have questions about  your specific Kaiser plan, the best thing to do is call member services at 800-464-4000.

Here are the main points:

  • The transgender benefit includes sexual reassignment surgery and mastectomy/chest reconstruction services, in addition to behavioral health and hormone therapy services. 
  • hysterectomies/oophorectomies are included as covered procedures in “bottom surgeries” for FTM individuals. If a hysterectomy is medically necessary for other reasons, surgery is covered no questions asked. If this surgery is pursued as it relates to gender transition, the surgery has to be reviewed by the “transgender surgical review board process”.
  • MTF breast augmentation is not a covered benefit
  • Cost sharing for these services is the same as cost sharing for other medical services for the employer group or individual’s plan (e.g., inpatient hospital cost share, office visit cost share, etc.).
  • The benefit has no lifetime dollar cap on services, even for employer groups that previously purchased KP’s optional transgender surgery rider that included a lifetime dollar cap.

What other KP lines of business include transgender benefits?

  • Medi-Cal
  • KPIC insured plans, based on regulations issued by the CA Dept of Insurance (KPIC is currently determining the scope of transgender benefits required under the regulations)
  • Benefits in these plans are not affected by the DMHC April 9 directive.

Which plans and market segments are not in scope for transgender benefits at this time?

  • FEHB
  • Medicare (except for Group KPSA (Kaiser Permanente Senior Advantage) plans in instances where the employer group has purchased optional coverage for transgender services)
  • Self-Funded employer groups (except for self-funded groups that have specifically elected to cover transgender services)

What travel and lodging is covered as part of the transgender benefits?

The travel and lodging is covered for:

  • ·      NCAL members traveling to Arizona
  • ·      SCAL members traveling to either Arizona or San Francisco

Are other states taking similar action?

  • Yes.  Regulators in Colorado, Oregon and the District of Columbia have taken similar action as in California.  No determinations have been made in those regions yet in terms of immediate action steps or changes to practice.  Other states may take similar or different action in the future.

Southern California Contact:  TransgenderCare@kp.org

Northern California Contact: Terri Hupfer Terri.Hupfer@kp.org

www.kp.org/eastbay/transgender

Not sure what your insurance company is doing about this? Call them! Ask them how their policies have changed and what procedures are now covered. Please, let me know what you find out at tandotherapy@me.com.

Update 8/1/13: Matt Wood of the Transgender Law Center offers further explanation and clarification:

Kaiser is an insurer, and as such it offers a variety of plans.  It’s important to help people understand the difference between a plan and an insurer.  In the past, certain plans included care for SRS, and certain ones didn’t.  So people used to call me and ask if they should insure themselves with Kaiser or Blue Cross, because they heard Kaiser offered trans care. The truth of the matter was that all insurers offered all care – it just depended upon what plan you or your employer contracted for.  We have argued all along the while exclusions themselves weren’t unlawful, those based upon gender identity were. The problem was that Kaiser and other insurers had exclusions that were worded as if they solely applied to trans people (“no care related to transsexualism”) as opposed to exclusions based upon procedures (“no hysterectomies”).

As a result, the DMHC issued its letter saying that all medical care that is medically necessary for gender transition and that is available to non-trans people cannot be excluded. There’s no distinction between MTF and FTM care, or bottom and top surgery. All *could* be covered, depending upon a person’s unique medical circumstances.  But we’re hearing right now that they don’t want to do any trans related surgeries for people with plans that formerly had exclusions until they have received more information from DMHC. We’re not sure why this is. We expect to get more clarification within 6 months, but that is a huge burden for many people with HMOs, not just Kaiser.

Medi-cal is different.  Medi-cal is a federal program administered by states at the county level. Medi-Cal has never excluded transition-related care (top, bottom surgery or HRT). However, depending upon which provider the county contracted with, that provider might have been misinformed and told a person there was an exclusion.  Some people have Medi-Cal through HMOs. Some have it through fee for service (find their own doctor who accepts and get reimbursed).  The affordable care act will make it more likely that people will have HMOs.  Some counties contract with Kaiser (esp here in the Bay Area). But other counties don’t.  But Exclusions don’t now, and haven’t in the past, been a legal barrier to care. Barriers have been ignorance of providers and lack of available providers (those that accept medi-cal reimbursement rates, which are supposedly among the lowest in the nation).

The Director’s letter applies to *all* HMOs, not just to Kaiser, as well as to all plans – including those offered by employers and schools, as well as those purchased by individuals. The only exception is that it does not apply to HMO plans that are offered by companies that are to “self-insured.” Many large companies are self insured, so check your plan carefully. If your company is self-insured and offers an HMO plan, it is not subject to the Director’s letter.

What this means:
1) An HMO cannot deny to a transgender patient the same medical procedure it covers for a non-transgender person. So if an HMO will cover a non-trans person’s hormone therapy for some medical reason, it must cover hormone therapy related to gender transitions for trans people. Similarly, if an HMO offers genital surgery to a non-trans person for some reason, it cannot deny it to a transgender person who seeks it as part of their treatment for gender dysphoria/GID.

2) HMOs are not required to cover all types of transition-related care. Rather, they are required treat trans and non-trans people the same in the provision of covered care. So, for example, if an HMO does not provide coverage for a hysterectomy for a non-trans woman, then it does not have to provide coverage for a hysterectomy for a transman based upon his gender transition.

3) HMOs offer “managed care” and a primary way they save costs is by contracting with specific physicians and surgeons. These medical professionals then become part of the HMO’s “network.” As a result, if the HMO already has someone in network who can perform top surgery or GRS, then you must use that in-network provider. If you want to go to a specific surgeon that you choose, ask them first if they are part of the HMO’s network. If they are not and you still want to go to them, you’ll have to pay for the procedure out-of-pocket. In some rare cases, as deemed appropriate by the HMO and based upon a person’s unique medical circumstances, the HMO may choose to cover medical care by a provider who is not in its network.

4) Finally, there is still much confusion about what the Director’s letter means, and we are aware of transpeople who are still being denied covered care by HMOs. If this happens to you, please contact the Transgender Law Center at 415-865-0176 x306 or online at: http://transgenderlawcenter.org/help

To read the Director’s letter and learn more, go to TLC’s website –http://transgenderlawcenter.org/archives/4273

Published in: on June 21, 2013 at 2:46 pm  Comments (17)  

Insurance Victory

An issue that has caused frustration, sadness, and exasperation (and that is just for me- imagine how my clients must feel!) is the issue of exclusions for transition-related services for transgender individuals. Most healthcare plans have specific exclusions for anything related to gender transition. This includes but is not limited to hormone blockers, hormones, and needed surgery for transgender individuals.  In my opinion, this is as outrageous as healthcare plans excluding other major medical conditions. These exclusions leave me feeling very helpless, as I can see so clearly what my clients need: medical transition. And I cannot provide this!

As important as being able to access medical transition is being able to access EARLY medical transition when clinically necessary. However, even with the support and assistance of their parents, many transgender youth run into roadblocks when trying to get hormone suppressors. They are outrageously expensive, and most health insurances have exclusions that state they will not pay for anything related to gender transition. (Can you imagine, being one of these preteens/teens who are right on the doorstep of getting the treatment they so desperately need to survive, but they cannot afford it?)

Such is the same for many of my transgender adult clients. Surgery is an important part of the transition for most of my adult transgender clients, and yet most insurances will not cover it. This is a major power problem for those who cannot afford to pay for such surgeries out-of-pocket. It is my opinion that they shouldn’t have to.

On April 9, 2013, a ground-breaking ruling was made on this issue:

“California’s Department of Managed Health Care (DMHC) has ordered California’s health plans to remove exclusions of coverage based on gender identity and expression…The newly issued DMHC letter instructs health plans to revise current plan documents to remove exclusions and limitations related to gender transition.  For transgender people, how and when they transition is typically a private decision made with their doctor. The American Medical Association, American Psychological Association, American Psychiatric Association, and the American Academy of Family Physicians have all deemed transition-related care to be medically necessary for transgender patients.” Read more about it here.

I am truly curious to see how this plays out with all of my clients, and hope it is in reality as good as it sounds! To progress!