AUGUSTA — A wide range of health care and human rights advocates urged lawmakers on Wednesday to protect access to gender-affirming medical care in Maine as states around the country move to restrict such treatments.

Gov. Janet Mills added coverage of gender-affirming care such as mental health counseling, surgery and hormone treatments under the state’s Medicaid program in 2019. But a bill before the Legislature would enshrine that policy in state law so that a future administration could not easily eliminate the coverage.

“Gender-affirming health care all across this country, despite its support by every major medical organization in the United States, is being targeted by a nationally coordinated campaign,” said Quinn Gormley, executive director of the Maine Transgender Network.

“We need to make sure that regardless of how the legal landscape changes at the state and federal levels, that this care is protected.”

Medicaid is funded by the federal government but administered by the states. As of July 2021, Maine and Illinois were the only U.S. states to offer Medicaid coverage for a full range of gender-affirming care, including surgery, hormone therapy, voice/communication therapy, mental health counseling and fertility services, according to a survey by the Kaiser Family Foundation that received responses from 40 states.

Another 29 states provide some Medicaid coverage for some types of gender-affirming care, while two states, Texas and Alabama, explicitly exclude coverage, according to the foundation. Such care is not addressed in the policies of seven other states.


Republicans across the country have been attacking policies that recognize and support transgender individuals, including by seeking to prohibit discussions about gender identity from classrooms and removing books from school libraries. They’re pushing policies to prohibit teachers from using a child’s preferred pronouns without parental consent and trying to ban trans athletes from sports and using bathrooms of their choice.

At least 450 anti-LGBTQ bills have been proposed in state legislatures across the United States, with Texas and Oklahoma leading the way with 51 and 35, respectively, according to the American Civil Liberties Union, which says four anti-LQBTQ bills have been introduced in Maine. About 118 of the bills in other states pertain to health care.

Gender-affirming care includes a range of services, including medical care, mental health care and social services. It’s supported by the leading medical and mental health associations in the U.S.

Fifteen states restrict gender-affirming care for people under 18 years old, and 18 other states, including New Hampshire and New Jersey, are considering bans on gender-affirming care for people under the age of 18, according to Human Rights Watch.

“Gender-affirming care helps transgender and non-binary people live openly and authentically as their true selves,” Human Rights Watch says. “Just like any other form of healthcare, it also helps transgender and non-binary people live safe and healthy lives. Gender-affirming care is always delivered in age-appropriate, evidence-based ways, and decisions to provide care are made in consultation with doctors and parents.”

Rep. Matt Moonen, D-Portland, is sponsoring the bill, L.D. 1040, that would codify coverage under MaineCare, solidifying Maine’s status as a leader in providing gender-affirming care.


Moonen said the state already has adopted anti-discrimination policies under the Affordable Care Act into state law. That move required private insurance to cover gender-affirming care.

“That covered private insurance, but it did not cover MaineCare,” Moonen said, emphasizing that his bill would not add any costs or coverage to the existing MaineCare program. “It takes what is in the rule and puts it into law.”


Nobody testified in person against the bill. But the Christian Civic League of Maine submitted written testimony in opposition, saying they’re worried that adults will allow “confused” teenagers to make life-altering choices that cannot be reversed.

“I focused on children but feel the same for adults,” said Mike McClellan, the group’s policy director.

Gormley, the executive director of the Maine Transgender Network, said a 2021 Maine Transgender Community Survey showed that 27% of transgender Maine residents are on MaineCare. That represents nearly 4,000 Mainers, and about 70% of them access gender-affirming care, she said.


“It really was an extraordinary change,” Gormley said of the 2019 rule.

Equality Maine Executive Director Gia Drew testified in support of the bill on behalf of her organization and the Maine Women’s Lobby, the Maine Chapter of the American Academy of Pediatrics, ACLU of Maine and GLAD Legal Advocates & Defenders.

Drew said the patchwork coverage of gender-affirming care across the country shows that the existing federal rules prohibiting discrimination against people because of sexual orientation and gender identity are open to interpretation.

“We want to ensure this is plainly stated in Maine law so that people can get the care they need,” Drew said. “Of course, there is real fear in our community that what is happening in states across the country causes harm here in Maine.”

Moonen’s bill also was supported by the Mabel Wadsworth Center, Maine Consumers for Affordable Health Care, the Maine Coalition Against Sexual Assault, the Maine Prisoner Advocacy Project and Maine Equal Justice.

The Health and Human Services Committee is expected to schedule a work session on the bill in the coming weeks.

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