The Effect of Improved Health Insurance Coverage on Access to Gender Affirming Surgeries for Transgender Patients at Ohsu between 2012 and 2017

Abstract

Background:

Oregon Health & Science University’s (OHSU) Transgender Health Program is one of the largest, total care, transgender health programs in the country. This research aims to understand the profile of transgender patients seen for gender affirming care at OHSU, especially given the January 1, 2015 initiation of expanded Medicaid Oregon Health Plan (OHP) coverage for gender affirming surgical care.

Methods:

Patients were selected based on having undergone a gender affirming procedure since January 1, 2012. Age, gender, state of residence, insurance coverage, total RVUs, work RVUs, number of procedures received (based on CPT codes), procedure areas, and other covariates from electronic health records and health system financial databases were described. The number of procedures received that were covered or not covered by OHP based on insurance status across all years was examined.

Results:

With the onset of OHP coverage and expanded physician services, OHSU saw an increase in patients receiving gender affirming care from 57 from January 1, 2012 to December 31, 2014 to 1326 (1302 new patients) from January 1, 2015 to December 31, 2017. Focusing on patients who received care after 2015 (n=1326), 49.7% (n=659) received surgical procedures in that time. In terms of procedure area, based on CPT codes, 3% of surgeries were performed on the trunk, 63% on breasts, 19% on male reproductive structures, and 15% on female reproductive structures.  Half of patients (n=317) had OHP as primary insurance. Patients with OHP insurance were more likely to have procedures that were covered by OHP than people without OHP.

Conclusions:

The number of patients receiving gender affirming care at OHSU has increased from 57 to 1326 since the expansion of Medicaid coverage in 2015. While it’s unclear the degree to which the implementation of this insurance policy improved access to surgical services, there is a marked increase in patients with OHP receiving newly covered gender affirming services.