The Role of Medicaid Plans in Assuring LGBTQI+ Access to Care

Medicaid plans have a key role to play in improving access to care and health equity for the LGBTQI+ community, according to a report from the Association for Community Affiliated Plans (ACAP).

“A great deal of work remains to be done to improve health equity for LGBTQI+ people,” Margaret A. Murray, chief executive officer of ACAP, said in a press release. 

“By highlighting solutions already in place in the Medicaid sphere, we hope this report can serve as a starting point to recognize and remove barriers that allow disparities in health to persist. ACAP and our member Safety Net Health Plans are fully committed to rooting out health inequities of all kinds. This report represents one of many steps forward.”

The report noted several areas in which Medicaid programs can improve their care for LGBTQI+ individuals and offered four case studies to elucidate what community health plans are doing to address these areas.

First, Medicaid health plans can offer coverage for medically-necessary, gender-affirming services and benefits. 

Across the health insurance industry at large, this has been difficult to achieve, despite the fact that payers are not without guidance on what would qualify as medically necessary. The WPATH Standards of Care and the Human Rights Campaign’s (HRC) Corporate Equality Index clearly delineate how payers can make this distinction.

Second, payers can offer targeted member services specifically designed to support the needs of members in the LGBTQI+ community. These efforts can take many forms. 

For example, CHOICE Health Plans from the Visiting Nurse Service of New York (VNSNY), an ACAP member, offers a special needs plan for individuals with HIV called SelectHealth. 

The health plan covers behavioral healthcare as well as physical healthcare needs, drawing its provider network from designated AIDS centers, Federally Qualified Health Centers, and specialists who focus on HIV care. 

SelectHealth also connects members with appropriate social services. The plan implements a peer partnership program that connects members with an individual who can help them eliminate barriers in access to care.

Third, payers cannot be expected to properly support members in the LGBTQI+ community alone—in fact, they should not offer support in isolation. Rather, they should partner with providers who specialize in care for LGBTQI+ individuals.

Amida Care Health Plan (Amida Care), a member of ACAP, worked with a provider partner to sponsor the Transgender Health Conference in New York City. Additionally, it is coordinating with its federally qualified health center partners and other providers to expand gender-affirming services. The plan and its providers also collaborate to improve home healthcare after gender-affirming surgeries.

Fourth, not only should payers draw in providers who specialize in LGBTQI+ care, but they should also make an effort to include members of the LGBTQI+ community by establishing advisory council groups consisting of LGBTQI+ community members.

University of Pittsburg Medical Center Health Plan (UPMC) sought to engage the community by coordinating with LGBTQ community centers, an approach that the payer found to be particularly critical for achieving better access to care in rural healthcare settings.

Fifth, payers should engage in LGBTQI+ community events as a form of outreach.

For instance, Amida Care is involved in LGBTQI+ Pride events and has sponsored events with the Kiki Coalition with the goal of supporting LGBTQI+ youth.

Sixth, payers need to leverage their relationships with employers in order to improve care for the LGBTQI+ community.

Amida Care publishes a magazine that addresses the high unemployment rate for members with HIV, provides job training, has established employment placement programs, and works to address social determinants of health needs such as housing instability and food insecurity. 

The health plan has also worked with the Transgender Legal Defense and Education Fund to provide access to legal services, which LGBTQI+ community members must leverage sometimes in order to access care.

Other payers have partnered with a diverse set of business leaders to ensure strong representation in their partnerships.

Seventh, certain LGBTQI+ organizations offer approvals and certifications for entities and businesses that effectively support LGBTQI+ community and individual interests. Payers can seek out these certifications to achieve them as a measure of quality of care.

UPMC, for example, achieved a 100 percent rating on the 2020 Human Rights Campaign Corporate Equality Index. And VNSNY CHOICE Health Plan was the first organization in three different areas of the state of New York to receive the highest possible certification from Services and Advocacy for LGBT Elders (SAGE).

Lastly, payers can also advocate for the LGBTQI+ community on a regulatory level, using their influence to promote better care and better legal protections for members in this community.

UPMC joined the Pennsylvania Governor’s Commission on LGBTQ Affairs in order to have a hand in the policymaking process around LGBTQ communities. The Commission has an impact on state policies by keeping the governor and state agencies informed about the LGBTQ community’s needs.

“No one should hesitate to seek medical care when they need it. It is both shameful and entirely preventable that so many LGBTQI+ people do so rather than endure the discrimination, harassment, and even refusal of services that too often await us,” Harper Jean Tobin, LGBTQI+ policy advocate and former policy director of the National Center for Transgender Equity, said in the press release.

“Reducing disparities requires concerted efforts like those laid out in this report from health plans and others to support and make space for LGBTQI+ people.”