BILL NUMBER: S9275
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the social services law, in relation to requiring Medi-
caid to cover gender-affirming care regardless of federal funding; to
amend the executive law, in relation to prohibiting discriminatory prac-
tices 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 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 three amends section heading and the opening paragraph and para-
graphs 4, 7 and 8 of subsection (a) of section 3243 of the insurance
law, as it relates to discrimination because of sex or marital status in
hospital, surgical, or medical expense insurance, to expand protections
to race, national origin, age, or disability, color, creed, and preex-
isting conditions.
Section three also adds four new paragraphs 9, 10, 11, and 12 to
subsection (a) of section 3242 of the insurance law, 9) to include a
policy clause to protect insured's sexual orientation, gender identity
or expression, or transgender status; 10) to protect their right to
medically necessary services or treatment from exclusion; 11) to prohib-
it sexual orientation, gender identity or expression, or transgender
status being deemed as pre-existing conditions for the purpose of deny-
ing, limiting, or excluding of coverage; and 12) to prohibit the denial
of a claim solely based on the gender of the insured unless the insurer
has taken reasonable steps to determine that the insured is ineligible
for the service, prior to denial of such a claim.
Sections four through six amend: sections 4303 of the insurance law by
adding a new subsection (xx); subsection (k) of section 3221of 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 to provide medically necessary services or treatment
otherwise covered by a policy on the basis that the treatment is for
gender dysphoria or gender incongruence. Coverage for gender dysphoria
or gender incongruence would not be subject to annual deductibles or
coinsurance, including co-payments, unless the policy is a High Deduct-
ible Health Plan, in which case coverage would be subject to the plan's
annual deductible.
Section seven establishes a severability clause.
Section eight 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