Legislature could create barriers to gender-affirming care for Wyoming Medicaid patients

Some Medicaid patients seeking gender-affirming care in Wyoming could feel the impact of a budget change passed this week in the House and Senate. 

Lawmakers in both chambers adopted identical budget amendments Monday and Wednesday that would bar state funds from being used to pay for gender-affirming treatments in Wyoming. 

The proposed change — sponsored in the House by Reps. Sarah Penn (R-Lander), Pepper Ottman (R-Riverton), Ken Pendergraft (R-Sheridan) and Jeanette Ward (R-Casper) and in the Senate by Sen. Lynn Hutchings (R-Cheyenne) — would bar state funds from being used for gender reassignment surgeries or the administration of puberty blockers, testosterone and estrogen, with exceptions for people “born with a medically verifiable genetic disorder of sex development.” 

Lawmakers who supported the proposal said gender-affirming care is elective treatment, and that the state shouldn’t pay for it. Opponents were concerned that the change could go against best medical practice in some cases. They also took issue with addressing gender-affirming care through the budget rather than through legislation — and by controlling the purse strings of the Wyoming Department of Health. 

“My problem with this is we shouldn’t limit how an agency works by their funds,” Rep. Lloyd Larsen (R-Lander) told lawmakers Monday.

“Let’s continue to develop policy, particularly on how the state approaches gender reassignment.” 

The proposal would also block state funds from being used to pay for abortions in Wyoming, with some exceptions. But the Wyoming Department of Health already follows a federal provision that prevents it from paying for abortions except in cases of rape or incest, or if the mother’s life is in danger. 

The proposal can’t be negotiated further in the Legislature since lawmakers in both chambers approved of the change. But Gov. Mark Gordon still has the power to veto specific items in the budget after lawmakers pass the entire budget bill. 

If the provision does remain in the budget, it would be the first time the Wyoming Legislature has successfully curbed access to some gender-affirming care in Wyoming. The move is part of a growing trend among Republican-controlled legislatures, which have passed dozens of bills this year aimed at transgender people.

In the past, Wyoming lawmakers have attempted to push bills that would put up barriers to gender-affirming care for minors. Those attempts have so far been unsuccessful. Lawmakers are trying again this year. 

Medicaid reimbursements

It’s not entirely clear how these budget amendments could impact gender-affirming treatment access in Wyoming. The Wyoming Department of Health doesn’t provide direct funding for facilities in Wyoming that offer gender-affirming care, Kim Deti, the agency’s spokesperson, told WyoFile. 

The amendment, however, could affect Medicaid reimbursements for such treatments. 

“The biggest role really that our department plays in health care in Wyoming is through Wyoming Medicaid,” Deti said. 

In Wyoming, the pool of people who qualify for Medicaid coverage is very limited. Lawmakers here have rebuffed attempts to adopt Medicaid expansion for more than a decade, and the state’s Medicaid program limits eligibility to low-income people who also fall under a certain age or in particular physical health categories — low-income children and those on supplemental security income, for example. 

Medicaid can only cover gender-affirming treatments that are considered “medically necessary” under the department’s administrative rules. 

The department, Deti said, has never used any of its funds to pay for gender reassignment surgeries — procedures that lawmakers are attempting to outlaw for minors in Wyoming, though there’s no evidence such surgeries are performed on children in the state. 

“We have no plans to allow coverage of that procedure, and our administrative rules would prohibit coverage of such a surgery,” Deti said. 

The health department’s programs sometimes cover “limited” gender-affirming care when it’s deemed medically necessary. Deti said this is “a pretty rare situation.” 

Between 2018 and roughly mid-2023, Deti estimated the department spent less than $150,000 on gender-affirming service reimbursements. (WyoFile submitted a records request for the exact amount but wasn’t yet in receipt of the record by press time.) To put that in context, the department spent hundreds of millions of dollars annually on total Medicaid expenditures in Wyoming over a similar period, according to the 2022 Wyoming Medicaid report. 

Impacted providers

Julie Burkhart, founder of the Casper Wellspring Health Access clinic, which provides gender-affirming care, told WyoFile on Tuesday that the clinic does serve some Medicaid patients seeking gender-affirming treatments. (The clinic is also the only facility in the state that provides abortions.) 

“If we’re talking about the withdrawal of Medicaid funding for these types of health care visits, then there would be some impact on some of our patient population,” Burkhart told WyoFile. 

That being said, Burkhart wasn’t sure what portion of these treatments qualified for Medicaid reimbursements or exactly how many of their patients could be affected. 

“Now that it’s here, we’ll be looking into it further, because the last thing we want to do is to be in violation of insurance requirements and reimbursement parameters,” Burkhart said of the amendment. “Even though we want to be able to provide care for folks and also to use their insurance, we don’t want to get sideways with the state or any other insurance company.” 

The budget amendment brings into question how the clinic and its patients will afford these treatments in states that are “inhospitable” to this kind of medical care. 

“At the end of the day, that’s an important question,” Burkhart said.

“As in abortion care, we have to go out and cobble funding together from different entities in order to make ends meet, and now it can be that same exact situation,” she said of funding gender-affirming care at the clinic. 

Another of Penn’s budget amendments related to gender-affirming care also won lawmakers’ approval Monday, but was later deleted by an amendment brought Wednesday by Rep. Bob Nicholas (R-Cheyenne). This proposal would have stripped the UW family medicine residency program of $100,000 if the program offered or performed gender-affirming treatments through its facilities. Hutchings brought the same amendment in the Senate but ultimately withdrew the proposal. 

Legislation

Lawmakers brought at least 10 bills to the session related to transgender people, gender-affirming care, pronouns, obscenity and school programming. Now, only three remain. 

Two of those bills address gender-affirming care in Wyoming. 

One bill would allow minors who received “gender transition services” to sue a doctor over that treatment until the age of 21. Another is similar to a bill that failed during last year’s session, minus a section about health insurance. The legislation would outlaw gender-affirming treatments for minors in Wyoming, including surgeries, hormones or puberty blockers. (Again, there’s no evidence that gender-affirming surgeries are performed on minors in Wyoming.)