Unraveling injustice: Race and class impact of medicaid exclusions of transition-related health care for transgender people

Abstract

This article explores how Medicaid policies excluding or limiting coverage for transition-related health care for transgender people reproduce hierarchies of race and class. In many legal contexts, a medical model informs views of transgender experience(s), often requiring proof of specific types of surgery prior to legal recognition of transgender people's identity and rights. Simultaneously, state Medicaid programs disregard the medical evidence supporting the necessity of transition-related care when considering whether to cover it. In this article, the authors analyze the contradiction between the medicalization of trans experience(s) and government's refusal to recognize the legitimacy and neces-sity of trans health care. The authors examine the social, economic, legal, political, medical, and men-tal health impact of these policies on low-income trans communities, paying particular attention to the disproportionate impact on communities of color. The authors conclude with recommendations for legal and health care systems to improve access to transition-related health care for low-income trans people. This article explores how Medicaid policies that exclude or limit coverage for transition-related health care 1 for transgender people reproduce hierarchies of race and class. The authors examine Medicaid policies that exclude transition-related health care, looking at such policies through the lens of social, medical, and legal sys-tems. These systems are intimately intertwined not only in determining when transgender 2 people's identities are