CARSON CITY, Nev. (AP) — Nevada Republican Gov. Joe Lombardo signed two bills related to transgender rights and vetoed another, bucking trends from other Republican governors who have pushed anti-transgender rhetoric and policies throughout the country.
The former Clark County Sheriff’s signing of a bill on Monday requiring health insurance companies including Medicaid to cover all gender-affirming surgeries was the third major bill related to transgender health and civil rights to reach his desk.
Another bill he signed earlier this month requires the states’ Department of Corrections to adopt mental and medical health standards for transgender and gender-nonconforming people inside the state’s prisons, including cultural competency training for guards.
Democratic-controlled Legislatures like Nevada’s have moved several bills protecting transgender health care, civil rights and legal protections including a half dozen states from Oregon to Colorado. But Lombardo’s signature comes as Republican governors throughout the country have curtailed transgender-related rights and medical procedures, widening the gap between the Republican base and the only Republican to unseat a Democratic incumbent governor in the 2022 midterms.
“Nevada has for a very long time been a live-and-let-live type of state,” said transgender rights advocate Brooke Maylath, who worked on all three bills. “And I’m glad to see that this governor has not been hijacked by the divisiveness that we’ve seen in other states.”
Still, Maylath criticized Lombardo for vetoing a bill earlier this month that would have protected providers of gender-affirming services from losing their medical license and prohibited the executive branch from assisting in out-of-state prosecution. She said that the absence of those protections would exacerbate Nevada’s already-existing provider shortage.
In his veto message, Lombardo said the bill would hinder his office’s ability to “be certain that all gender-affirming care related to minors comports with State law,” and to ensure public health and safety standards.
Lombardo’s latest signature for the bill requiring health insurance companies to cover all gender-affirming surgeries comes after Oregon’s Democratic governor signed a nearly-identical law in May.
Lombardo garnered criticized from many his own party after the bill signing, including from Nevada’s Republican National Committeewoman Sigal Chattah, who called him a “laughingstock across the nation” in a tweet.
“I implore people to read the bill in its entirety,” Lombardo said on Tuesday at a press gaggle for another bill signing, adding that it mainly shores up already-existing protections. “And you will see it’s not as draconian or detrimental or immoral as people are portraying it to be.”
Democratic Senator Melanie Scheible, one of the bill’s sponsors, had framed the legislation as a way to save the state money due to potential losses in lawsuits against state Medicaid. She cited a 2015 declaration from the state’s division of insurance that prohibits the denial of medically necessary care on the basis of gender identity.
“The idea is to clear up any ambiguity and to put the answer in the statute, instead of waiting for an answer from a court,” Scheible said in an interview earlier in the session.
Many credit the declaration as to why more major gender-affirming surgeries are increasingly deemed “medically necessary” rather than “cosmetic” in Nevada by insurance companies, thus making more gender-affirming surgeries covered.
Still, many procedures — hair transplants, facial feminization surgery and voice modification among them — are often still classified as “cosmetic” despite their role in treating gender dysphoria, regarded as a medical condition that results in severe distress because of a mismatch between gender identity and gender assigned at birth.
Proponents have said the bill does more to enshrine existing rights rather than expand coverage that would already be mandated when brought through the appeals process or the courts because of the 2015 insurance mandate. Opponents largely worried about potential costs to Medicaid and to health insurance agencies, as well as having opposition to gender-affirming surgeries as a whole, particularly for younger patients.
It passed along party lines in the state Senate and Assembly, with Republicans opposed.
Lombardo also bucked party trends earlier this month when he signed another bill into law that further codified already-existing protections that ensure commissions that oversee medical licenses do not discipline or disqualify doctors who provide abortions.
AdventHealth’s mental health expert gives advice to families as children return to school
ORLANDO, Fla. (FNN) – Dr. Tina Gurnani, a board certified pediatric and adolescent psychiatrist at AdventHealth for Children is a mental health expert gives advice to families as children return to school.
Half of all mental health illnesses begin by age 14, yet only one out of three parents regularly discuss mental health with their children, according to AdventHealth research. And for those who suffer, it can take up to 11 years to get a diagnosis and seek treatment.
Dr. Gurnani spoke about what children are facing, what parents can be on the lookout for as their kids head back to class and how AdventHealth for Children’s “Be a Mindleader” campaign can spark life-saving conversations around mental health.
Biden administration urges states to slow down on dropping people from Medicaid
JEFFERSON CITY, Mo. (AP) — The Biden administration on Monday urged states to slow down their purge of Medicaid rolls, citing concerns that large numbers of lower-income people are losing health care coverage due to administrative reasons.
The nation’s Medicaid rolls swelled during the coronavirus pandemic as states were prohibited from ending people’s coverage. But that came to a halt in April, and states now must re-evaluate recipients’ eligibility — just as they had been regularly required to do before the pandemic.
In some states, about half of those whose Medicaid renewal cases were decided in April or May have lost their coverage, according to data submitted to the Centers for Medicare & Medicaid Services and obtained by The Associated Press. The primary cause is what CMS describes as “procedural reasons,” such as the failure to return forms.
“I am deeply concerned with the number of people unnecessarily losing coverage, especially those who appear to have lost coverage for avoidable reasons that State Medicaid offices have the power to prevent or mitigate,” Health and Human Services Secretary Secretary Xavier Becerra wrote in a letter Monday to governors.
Instead of immediately dropping people who haven’t responded by a deadline, federal officials are encouraging state Medicaid agencies to delay procedural terminations for one month while conducting additional targeted outreach to Medicaid recipients. Among other things, they’re also encouraging states to allow providers of managed health care plans to help people submit Medicaid renewal forms.
Nobody “should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process,” Becerra said in a statement.
States are moving at different paces to conduct Medicaid eligibility determinations. Some haven’t dropped anyone from their rolls yet while others already have removed tens of thousands of people.
Among 18 states that reported preliminary data to CMS, about 45% of those whose renewals were due in April kept their Medicaid coverage, about 31% lost coverage and about 24% were still being processed. Of those that lost coverage, 4-out-of-5 were for procedural reasons, according to the U.S. Department of Health and Human Services.
In Arkansas, Florida, Idaho, New Hampshire and Oklahoma, about half or more of those whose eligibility cases were completed in April or May lost their Medicaid coverage, according data reviewed by the AP. Those figures may appear high because some states frontloaded the process, starting with people already deemed unlikely to remain eligible.
CMS officials have specifically highlighted concerns about Arkansas, which has dropped well over 100,000 Medicaid recipients, mostly for not returning renewal forms or requested information.
Arkansas officials said they are following a timeline under a 2021 law that requires the state to complete its redeterminations within six months of the end of the public health emergency. They said Medicaid recipients receive multiple notices — as well as texts, emails and phone calls, when possible — before being dropped. Some people probably don’t respond because they know they are no longer eligible, the state Department of Human Services said.
Republican Gov. Sarah Huckabee Sanders has dismissed criticism of the state’s redetermination process, saying Arkansas is merely getting the program back to its pre-pandemic coverage intentions.
But health care advocates said it’s particularly concerning when states have large numbers of people removed from Medicaid for not responding to re-enrollment notices.
“People who are procedurally disenrolled often are not going to realize they’ve lost coverage until they show up for a medical appointment or they go to fill their prescription and are told you no longer have insurance coverage,” said Allie Gardner, a senior research associate at the Georgetown University Center for Children and Families.
Georgia to take over health insurance market under new law
ATLANTA (AP) — Georgia’s state government will for the first time run its own marketplace for individual health insurance under a law that Gov. Brian Kemp signed Tuesday.
The Republican governor said during a ceremony at the state Capitol that the law would create a better way of people “knowing and comparing their health care insurance options” and bring “further competition to the field.”
“Georgians know their needs and those of their families best,” he said.
The law is one of three big changes that could affect hundreds of thousands of Georgians who get subsidized health insurance through the state and federal government.
Kemp’s administration also plans to launch in July a partial expansion of Medicaid to insure some able-bodied adults who have incomes below the poverty line but are working or attending school. And like all states, Georgia is reviewing the eligibility of all its 2.4 Medicaid recipients as a pandemic-era rule ends that blocked the state from removing any beneficiaries.
Senate Bill 65, allowing the state marketplace, took effect with Kemp’s signature. It reverses an earlier law which blocked the state from establishing its own health care exchange. That law was part of an effort to blockade Georgia from participating in the Affordable Care Act under then-President Barack Obama. However, the federal government has been providing coverage through the Healthcare.gov website, and nearly 900,000 Georgians signed up for individual coverage during the yearly enrollment period that ended Jan. 15.
Many Georgians with incomes above the poverty line can buy the policies at little to no cost because of federal premium subsidies, although copayments can be substantial. People with higher incomes can also buy policies on the individual market.
Georgia has not embraced the Obama-era changes. Kemp continues to refuse a full Medicaid expansion without work requirements, a step that could provide insurance for hundreds of thousands. But having Insurance Commissioner John King run a marketplace aimed at Georgians dials down the total disdain state Republicans once had for the Affordable Care Act. The state has also been spending hundreds of millions to subsidize high-cost claims, a step credited with lowering premiums on the individual market and enticing more insurers to offer coverage outside metro Atlanta.
Insurance Department spokesperson Weston Burleson said Georgia officials hope to launch the state marketplace as early as this November. However, federal officials could push back Georgia’s launch date until 2024. Federal rules usually require states to spend at least 15 months constructing their own marketplace.
The state market will be different from the one Kemp originally envisioned. He had wanted to place insurance offerings in the hands of private brokers who could sell both policies offering the bundle of coverage required under the Affordable Care Act, as well as policies with lesser benefits. Those policies might have been cheaper, but Laura Colbert, the executive director of Georgians for a Healthy Future, said they would have been worse for consumers.
“That would have really rolled Georgia back to the bad old times where insurers really had the leg up on consumers, where it was incredibly hard to compare plans,” Colbert said, calling Kemp’s original plan a “non-marketplace.”
President Joe Biden’s administration balked at Kemp’s plan, and after a legal wrangle, Kemp agreed to a central state marketplace that would only sell federally approved policies.
Kemp administration officials say they’re prepared to launch the marketplace quickly because of all the work they did on the earlier proposal, on which they spent at least $31 million.
A state-based market could have some advantages, Colbert said. For example, she suggested Georgia could extend its enrollment period past the normal Nov. 15-Jan. 15 window. She also suggested offering to let people buy health insurance using their income tax refunds, and a one-stop application for Medicaid, Peach Care insurance for children and the state marketplace.
“Some state-based marketplaces have done some really innovative things. I think it’s TBD on whether Georgia will get there or not,” Colbert said.