BILL NUMBER: S9275A
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the social services law and the public health law, in
relation to requiring Medicaid to cover gender-affirming care regardless
of federal funding; to amend the executive law, in relation to prohibit-
ing discriminatory practices by health care entities; and to amend the
insurance law, in relation to prohibiting discriminatory practices by
insurers and to coverage for treatment for gender dysphoria or gender
incongruence
 
PURPOSE OR GENERAL IDEA OF BILL:
Requires Medicaid to cover gender-affirming care regardless of federal
funding; prohibits discriminatory practices by health care entities and
insurers relates to coverage for treatments for gender dysphoria or
gender incongruence.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends subdivision 2 of section 365-a of the social services
law, as it relates to what qualifies as standard coverage, by adding a
new paragraph (oo) to include all medically necessary gender-affirming
care regardless of whether any federal funds are available for such
coverage.
Section two amends subdivision 7 of section 2510 of the public health
law to expand the definition of covered health care services under the
Essential Plan to include gender-affirming care.
Section three amends subdivision 9 of section 292 of the executive law
as it relates to the definitions within human rights law, to include
"health care entities" in the definition for "place of public accommo-
dation, resort, or amusement." And further defines the term "health care
entity," to include hospitals, certain providers and professionals, and
any state regulated health insurance plan.
Section four amends subdivision 2 of section 296 of the executive law,
as it relates to discrimination in places of public accommodation: to
make it an unlawful discriminatory practice for any person to refuse,
withhold from or deny any of the accommodations, advantages, facilities,
or privileges thereof to individuals based on predisposing genetic char-
acteristics or familial status in addition to other existing protected
classes.
Section five amends section 3243 of the insurance law to expand existing
discrimination protections to include age, race, creed, color, national
origin, citizenship or immigration status, sexual orientation, gender
identity or expression, military status, disability, predisposing genet-
ic characteristics, familial status, status as a victim of domestic
violence, or preexisting conditions. Currently, protected classes
include sex, marital status, pregnancy, childbirth, and related condi-
tions.
Section five also expands the list of prohibited discriminatory prac-
tices by health insurers insurance to include: denial, exclusion, or
limitation under a policy based on an insured's sexual orientation,
gender identity or expression, or transgender status; denial, exclusion,
or limitation under a policy to protect their right to medically neces-
sary services or treatment from exclusion; designating sexual orien-
tation, gender identity or expression, or transgender status being
deemed as pre-existing conditions for the purpose of denying, limiting,
or excluding of coverage; and denying a claim solely based on the gender
of the insured unless the insurer has taken reasonable steps to deter-
mine that the insured is ineligible for the service, prior to denial of
such a claim.
Sections six through eight amends sections 4303 of the insurance law by
adding a new subsection (yy); subsection (k) of section 3221 of the
insurance law by adding a new paragraph 24; and subsection (i) of
section 3216 of the insurance law by adding a new paragraph 42.
These amendments would require every policy which provides hospital,
surgical, or medical coverage shall also provide coverage for medically
necessary services, treatments for gender dysphoria, or gender incongru-
ence that are otherwise covered by the policy. Coverage for gender
dysphoria or gender incongruence would not be subject to annual deduct-
ibles or coinsurance, including co-payments, unless the policy is a High
Deductible Health Plan, as defined in the internal revenue code of 1986,
in which case coverage for gender dysphoria or gender incongruence may
be subject to the plan's annual deductible.
Section nine establishes a severability clause.
Section ten establishes the effective date.
 
JUSTIFICATION:
Access to gender-affirming care is a matter of medical necessity and
public health, and it is more critical than ever in light of escalating
federal actions that have actively undermined care for transgender and
gender-nonconforming individuals. Recent federal policies have not only
threatened or withdrawn funding for medically necessary gender-affirming
services, but have also fueled widespread misinformation that distorts
clinical evidence and stigmatizes an already vulnerable population.
These actions have created significant barriers to care, exacerbated
health inequities, and placed transgender and gender-nonconforming indi-
viduals at increased risk for adverse physical and mental health
outcomes, including heightened rates of depression, anxiety, and suici-
dality. Gender-affirming care is supported by major medical and mental
health associations as evidence-based, life-saving treatment. Denying
or restricting access is not rooted in science, but in ideology, and
directly harms patients.
Gender-affirming care is not limited to transgender and gender-noncon-
forming individuals, although it is presented as almost exclusively in
connection with those populations. Such care is administered to cisgen-
der patients, including those whose gender identity matches their sex
assigned at birth. Cisgender people have been utilizing hormone therapy
for decades to treat medical conditions such as erectile dysfunction and
for alleviating menstrual or menopause related symptoms. Other examples
include breast reconstruction after a mastectomy for cisgender women,
hair transplants for male-pattern baldness, body contouring procedures,
and testosterone therapy for cis men with low testosterone.
Gender-affirming care is predominately used by cisgender individuals,
highlighting the true intentions of the federal government and emphasiz-
ing the need for this legislation. New York State has a responsibility
to act decisively to protect access to medically necessary, evidence-
based care and to counteract the harmful effects of federal disinvest-
ment and disinformation. Ensuring Medicaid coverage and establishing
dedicated funding streams for gender-affirming care is essential to
safeguarding the health, dignity, and fundamental human rights of trans-
gender and gender-nonconforming New Yorkers.
This legislation is more imperative than ever at a time where the feder-
al government is challenging the mere existence of transgender and
gender non-conforming individuals, creating a danger to both the wellbe-
ing of these communities and their ability to receive healthcare. By
amending the human rights law to include healthcare entities, we are
guaranteeing the same protections and healthcare access for all New
Yorkers, regardless of sexual-orientation, gender-identity, race,
national origin, age, disability, color, and creed.
 
PRIOR LEGISLATIVE HISTORY:
2025: S6377-A HOYLMAN-SIGAL/A6596-A Rosenthal
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Immediately.

Statutes affected:
S9275: 365-a social services law, 365-a(2) social services law, 292 executive law, 292(9) executive law, 4303 insurance law, 3221 insurance law, 3221(k) insurance law, 3216 insurance law, 3216(i) insurance law
S9275A: 365-a social services law, 365-a(2) social services law, 2510 public health law, 2510(7) public health law, 292 executive law, 292(9) executive law, 296 executive law, 296(2) executive law, 4303 insurance law, 3221 insurance law, 3221(k) insurance law, 3216 insurance law, 3216(i) insurance law