Transgender Rights | Healthcare | New Hampshire

New Hampshire Transgender Healthcare Rights Q&A 

Èske plan swen sante yo ka diskrimine moun LGBTQ+?

In general, under federal and New Hampshire state law, nearly all health plans cannot discriminate on the basis of sex, and, because the Supreme Court ruling in Bostock v. Clayton Co. concluded that all gender identity and sexual orientation discrimination is a form of sex discrimination, nearly all health plans cannot discriminate against LGBTQ+ people.

What health care plan protections are provided by New Hampshire?

New Hampshire Law

RSA 415:15 prohibits “discrimination on the basis of gender identity with respect to the availability of any covered services, medications, supplies, or durable medical equipment.” 

RSA 417:4, VIII(b) prohibits “discrimination on the basis of gender identity with respect to the availability of any covered services, medications, supplies, or durable medical equipment.”

The Patient’s Bill of Rights law (RSA 151:21 XVI) states: 

“The patient shall not be denied appropriate care on the basis of age, sex, gender identity, sexual orientation, race, color, marital status, familial status, disability, religion, national origin, source of income, source of payment, or profession.” 

New Hampshire Insurance Department

Based on the above laws, in 2020 the New Hampshire Insurance Department issued a bulletin which stated in part: 

“. . .insurers are prohibited from denying, excluding, or otherwise limiting coverage for medically necessary services, based on an individual’s gender identity. Any offered services, medications, supplies, or durable medical equipment in a health insurance policy or contract must be provided to all individuals for whom a medical provider, in consultation with the individual patient, has determined that the services are medically necessary… Insurers should base coverage decisions on medical necessity rather than a person’s gender identity. The Department considers any blanket policy exclusions for health care services related to gender transition or any other form of gender dysphoria treatment as a violation of RSA 417:4, VIII(b) and RSA 415:15 in that such exclusions discriminate on the basis of gender identity.”

New Hampshire Medicaid

In 2017, the Joint Legislative Committee on Administrative Rules (JLCAR) approved proposed regulations from the Department of Health and Human Services that ended the discriminatory exclusion from Medicaid coverage of gender-affirming surgeries.

New Hampshire Medicaid coverage includes the following gender-affirming services, providing there is documentation of medical necessity: 

• Mastectomy 
• Breast augmentation
• Hysterectomy 
• Salpingectomy
• Oophorectomy 
• Genital reconstructive surgery

Are there any health care plans that are not protected under New Hampshire law?

Yes. Medicare and employer health plans that are self-funded (also known as self-insured) are governed by federal law.

Ki pwoteksyon plan swen sante gouvènman federal la bay?

Medicare

In 2013, Medicare removed the ban on coverage for treatment of gender dysphoria because it was “experimental” and began to cover medically necessary treatment for gender dysphoria.

Seksyon 1557 nan Lwa sou Swen Sante Abòdab (ACA)

Seksyon 1557 la fè li ilegal pou nenpòt founisè swen sante ki resevwa finansman nan men gouvènman federal la refize trete yon moun – oubyen pou fè diskriminasyon kont moun nan – ki baze sou sèks (osi byen ke ras, koulè, orijin nasyonal, laj oubyen andikap). Seksyon 1557 la enpoze egzijans menm jan an sou konpayi asirans sante ki resevwa asistans finansyè federal. Founisè swen sante ak konpayi asirans yo pa gen dwa, pami lòt bagay, eskli oubyen trete yon moun yon fason negatif sou nenpòt nan baz entèdi sa yo. Règ final Seksyon 1557 la aplike pou moun k ap resevwa asistans finansyè nan men Depatman Sante ak Sèvis Sosyal (HHS), Mache Asirans Sante yo ak pwogram sante ke HHS administre yo.

Anjeneral, Seksyon 1557 la pa aplike pou plan sante gwoup ki finanse tèt yo anba ERISA oswa plan kout tèm ki gen yon dire limite paske antite ki ofri plan yo tipikman pa prensipalman angaje nan biznis bay swen sante, ni yo pa resevwa asistans finansyè federal.

In May 2021, the Biden Administration announced that the Health and Human Services Office for Civil Rights (OCR) would interpret and enforce Section 1557 of the ACA and Title IX’s nondiscrimination requirements based on sex to include sexual orientation and gender identity. The update was made in light of the June 2020 U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.

In enforcing Section 1557, OCR will comply with the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb et seq., and all other legal requirements and applicable court orders that have been issued in litigation involving the Section 1557 regulations.

Tit VII

Pou anplwayè ki gen 15 anplwaye oswa plis, Tit VII entèdi diskriminasyon ki baze sou ras, koulè, relijyon, sèks ak orijin nasyonal nan anbochaj, revoke, konpansasyon, ak lòt tèm, kondisyon oswa privilèj travay. Tèm ak kondisyon travay yo gen ladan benefis swen sante patwone pa anplwayè a. Nan listwa, se pa tout otorite ki dakò ke Tit VII pwoteje travayè LGBTQ+ kont diskriminasyon.

However, the Supreme Court decision in Bostock v. Clayton Co. changes this because that ruling made it clear that sexual orientation and gender identity discrimination are forms of sex discrimination. Although the decision is about wrongful employment termination, it has implications for employer-sponsored health plans and other benefits. For example, employers may want to adjust group health plan coverage of gender dysphoria and related services, including gender-affirmation surgeries and review and compare benefits for same-sex and opposite-sex spouses.

Can religious employers discriminate against LGBT people?

Nan dat 8 Jiyè 2020, nan Lekòl Notre-Dame de Guadalupe kont Morrissey-Berru, the United States Supreme Court reaffirmed its stance on the application of ministerial exception to employment discrimination cases as established in earlier rulings. In doing so, the Court simultaneously raised an unanswered issue under Title VII: does the ministerial exception for religious employers allow those organizations to discriminate against employees or candidates based on their LGBTQ+ status?

It’s unclear at this point how the Court’s ruling in Lekòl Notre-Dame de Guadalupe kont Morrissey-Berru may impact the LGBTQ+ employees of religious employers, but religious organizations and employers should recognize that the ministerial exception does not apply to every position within their organizations. Rather, it is limited to those employees who truly perform religious duties. For example, the position of a school janitor who is only present in the building outside of school hours and is not responsible for transmitting the faith would likely not be considered ministerial in nature

Ki etap mwen ka pran pou m jwenn asirans pou tretman disfori sèks?

1. Premyèman, tcheke si plan sante w la bay pwoteksyon pou kalite tretman ou vle a lè w pran yon kopi "Rezime Benefis ak Pwoteksyon" plan an. 
2. Pifò plan asirans, ni piblik ni prive, gen egzijans detaye ki dwe satisfè pou jwenn pwoteksyon. Sa a patikilyèman vre si w ap eseye jwenn pwoteksyon pou yon operasyon ki gen rapò ak tranzisyon. Kidonk, kontakte plan sante w la epi mande yon kopi egzijans pou tretman w ap chèche a. 
3. Travay avèk terapis ak doktè ou yo pou asire w ke ou satisfè tout egzijans plan sante a. Dokimantasyon ki soti nan terapis ak doktè ou yo se faktè ki pi enpòtan pou detèmine si demann tretman ou an ap apwouve. 
4. Check what treatment requires pre-approval. In most cases, any surgery will require pre approval, and the plan may only pay if you use a surgeon that takes their plan. 
5. Si yo refize demann tretman w lan, chèche konnen rezon ki fè yo refize w la, epi, si w toujou panse ou kalifye pou tretman an, swiv pwosesis apèl plan an. Anjeneral, pral gen yon pwosesis apèl entèn anvan, epi, si w pa reyisi la, pafwa ou ka fè apèl nan yon ajans ekstèn. Asire w ke ou respekte dat limit yo—si w pa respekte yon dat limit, sa ka otomatikman mete fen nan kapasite w pou fè apèl. 
6. Keep GLAD informed if you are denied treatment. GLAD may be able to offer suggestions that can help you win your appeal. You can contact GLAD Answers by filling out the form at Repons GLAD oubyen pa telefòn nan 800-455-GLAD (4523). 
7. Malgre ke plis plan sante kounye a kouvri tretman pou disfori sèks, pwosesis pou jwenn tretman, sitou pou operasyon ki gen rapò ak tranzisyon, ka pran anpil tan epi li ka fwistre. Yo bezwen anpil dokiman epi jwenn yon chirijyen ki fè kalite operasyon an, epi ki akseptab tou pou plan sante a, ka difisil. 
8. Pa pè pèsiste epi depoze dosye a ankò si yo refize ba ou. 

Kijan pou m jwenn yon chirijyen ki pral pran asirans sante mwen an?

De pli zan pli chirijyen ki fè operasyon pou chanje sèks pran asirans sante. Ou ta dwe fè rechèch sou chirijyen yo ak anpil atansyon pou jwenn youn ki bon pou ou. Ou ka gade lis founisè ki nan rezo a ke plan ou an bay pou wè si yo enkli oswa si li gen ladan nenpòt chirijyen nan zòn ou an, epi si non, ou ka kontakte biwo chirijyen an pou detèmine si yo aksepte asirans ou an. Pifò plan asirans sante egzije pou ou itilize yon founisè medikal nan rezo ou a, men si rezo ou a pa gen ladan yon chirijyen ki fè sèvis ou bezwen yo, ou ka kapab soti nan rezo a si ou mande otorizasyon alavans nan men plan ou an.

Kisa m ta dwe fè si y ap fè diskriminasyon kont mwen nan swen sante?

If you are being discriminated against by a health care facility or provider, you can file a discrimination complaint with the New Hampshire Commission for Human Rights. See the “Discrimination” Issue Area for detailed information about how to do this.

If you have a health care plan that is regulated by the New Hampshire Department of Insurance, you can file a complaint with that agency: New Hampshire Insurance Department – Complaint Filing.

Si ou gen yon plan swen sante ki gouvène pa Seksyon 1557 nan ACA a, ou ka depoze yon plent nan Biwo Dwa Sivil Depatman Sante ak Sèvis Sosyal federal la. Pou plis enfòmasyon, gade: How to File a Civil Rights Complaint. 

Si ou gen yon plan swen sante ki finanse tèt ou atravè yon anplwayè ki gen omwen 15 anplwaye, ou ka depoze yon plent pou diskriminasyon bay Komisyon Egalite Opòtinite nan Anplwa (EEOC) federal la. Pou plis enfòmasyon, gade Zòn Pwoblèm "Diskriminasyon" an.

Resous

New Hampshire Medicaid Handbook: New Hampshire Medicaid Care Management Program Member Handbook. 

The New England Transgender Healthcare Consortium consists of providers from over one dozen healthcare facilities in New England who are dedicated to improving access to gender affirming. For more information, see:  New England Gender CARE. 

New Hampshire Health Care Guidance: Health Insurance Guidance – New Hampshire.

New Hampshire Transgender Resources:  New Hampshire transgender resources. 

Legal Defense & Education Fund memo to plan administrators on liability for transgender health care exclusions:  Liability for Transgender Health Care Exclusions in Employer Health Plans 

Polis Asirans Sante ak Polis Medikal: Health insurance Medical Policies. 

Enfòmasyon sou plan Out2Enroll ACA pou 2022: Plan Information for 2022 – Out2Enroll. 

Swen sante pou moun transjèn: Transgender health care coverage | HealthCare.gov. 

HHS will enforce Section 1557 to protect LGBT people: HHS Will Enforce Section 1557 To Protect LGBTQ People From Discrimination | Health Affairs. 

Sant Nasyonal pou Egalite Transjan (NCTE): Konnen dwa ou nan swen sante: Know Your Rights: Healthcare.

Gid Swen Sante NCTE:  Health Coverage Guide | National Center for Transgender Equality. 

EEOC Title VII discrimination protections for LGBT people: Protections Against Employment Discrimination Based on Sexual Orientation or Gender Identity.

Gid pou Chirijyen ki espesyalize nan kesyon sèks: TransHealthCare.

Ka ak Defans

To see Transgender Rights cases or advocacy which GLAD has been directly involved with in New Hampshire, go to: Ka ak Defans – GLAD and under “By Issue” click on “Transgender Rights” and under “By Location” click on “New Hampshire.”

Nouvèl ak Kominike pou laprès

To see news and press releases about Transgender Rights in New Hampshire, go to: Nouvèl ak Kominike pou laprès – GLAD and under “By Issue” click on “Transgender Rights” and under “By Location” click on “New Hampshire.”