gender reassignment surgery laws in oregon

Gender Spender

Kim lacapria, published july 10, 2015.

FACT CHECK:   Does Oregon now allow young teenagers to obtain gender reassignment (sex change) surgery without the knowledge or consent of their parents?

Claim:     Oregon quietly enacted a taxpayer-funded policy that allows minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents.

Example:   [Collected via Twitter, July 2015]

You’ve got to be kidding me! Oregon 15-yr-olds are now allowed to get sex-change operations—w/o parental notification https://t.co/Ldu0p2z3X7 — Franklin Graham (@Franklin_Graham) July 10, 2015

COMING UP: Oregon allowing 15 yr olds to get state-subsidized sex-change operations w/o parental consent-thoughts? @genemarks @DrDanielBober — Gretchen Carlson (@GretchenCarlson) July 10, 2015

Origins:    On 9 July 2015 Fox News published an article titled "Oregon allowing 15-year-olds to get state-subsidized sex-change operations," (accompanied by several broadcast segments) claiming that a recently approved policy in the state enables minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents.

The article (subsequently aggregated to a number of web sites without additional investigation) stated:

The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo — even go to a tanning bed. But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notification — and the state will even pay for it through its Medicaid program, the Oregon Health Plan.

A Portland transgender advocate addressed the claims made in the article, indicating that the assertions were implausible with respect to the mechanics of gender reassignment surgery:

Jenn Burleton, the executive director of TransActive Gender Center in Portland, said the idea a 15-year-old can walk into a doctor’s office, say they want gender affirmation surgery and get it done without a parent’s consent is unrealistic. “It’s irrational,” she said. “It’s laughable.”

The Oregon Health Authority also released a statement about the such claims, explaining that the age of medical consent in Oregon (15) and coverage of gender dysphoria as a medical condition in no way suggested that teens of that age were in actuality undergoing surgery without the knowledge or consent of their parents:

In Oregon, the age of medical consent is 15 or older. Patients should be able to demonstrate the capacity to make a fully informed decision and to give consent to treatment, regardless of age. However, nothing in Oregon law requires a health care provider to provide medical services to a minor or safeguard the confidentiality of a minor. In most cases, providers will encourage (and in some cases require) family engagement and supports unless it would endanger the patient.

The documents to which Fox News referred (which purportedly "quietly" approved gender reassignment for teens) in actuality assessed aligning Oregon's public health coverage (for patients of all ages) with the general standard of treatment for gender dysphoria. Surgery was listed as one of several options available to patients under later revised guidelines and was not specific to minors:

Updating Oregon’s policy and bringing it into line with current major international treatment guidelines, the Health Evidence Review Commission (HERC) has voted to move gender dysphoria into the covered portion of the Prioritized List with the publication of the next biennial review List. Services already approved for this new, covered line include psychotherapy, medical visits, and medications to suppress puberty in gender questioning youth.

The only portion of the documents in question pertaining to minors did not mention parental consent and simply referenced "medications to suppress puberty in gender questioning youth." In terms of utilization estimates in the June 2014 document, Oregon's Health Evidence Review Commission stated that 175 total Oregonians (not specifically or even primarily teens) would likely be covered under the inclusion each year:

HERC staff estimate a utilization rate (of all treatments for gender dysphoria) in OHP of 175 persons in any 12 month period. HERC staff estimates that the total cost of adding all treatments for OHP will be less than $150,000 per year.

The numbers provided are not insignificant with respect to an estimated number of surgeries performed each year. A 2015 Washington Post article quoted two medical experts who estimated that "a woman who chooses the full range of surgical procedures available would spend $75,000 or more to transition to a male," but surgically transitioning "from male to female might cost in the $40,000 to $50,000 range." So even factoring in the lowest cited cost of $40,000 per individual surgery (and the fact that the estimates included all Medicaid patients in Oregon treated for gender dysphoria, not just minors), the "less than $150,000 per year" estimated spending would cover just three patients — with hardly anything left over for non-surgical treatments such as counseling and medication.

The Fox article also cited a 2008 study that stated "most children with gender dysphoria will not remain gender dysphoric after puberty," implicitly suggesting that children in Oregon who might opt for gender reassignment surgery (without any input from their parents regarding the serious health decision) would invariably come to regret their hasty course of action later in life. However, Fox elided the portion of the study that indicated the children presenting as gender dysphoric had an "age range [of] 5-12 years," meaning all study participants were well under the threshold age of medical consent in Oregon. That omission was in contrast to the wording of Fox's headline, which specifically cited minors aged 15 and over (none of which were included in the cited study).

It's true that the age of medical consent in Oregon is 15 (whether or not a minor is transgender), and in early 2015 the state of Oregon's HERC did opt to include gender dysphoria in a list of conditions covered by the state's Medicaid plans. But publicized claims misled readers and viewers into thinking that a new guideline had approved "sex changes" for teenagers by conflating extant Oregon state policies that were largely unrelated.

In fact, the age of medical consent in Oregon has been 15 since 1971, and gender dysphoria Medicaid coverage changes applied to all residents of the state (not teens specifically). The Fox article (and subsequent iterations) failed to consider the lengthy, arduous process gender reassignment entails or the likelihood that any medical provider would agree to begin such a process on a minor who lacked parental consent. Moreover, the policy change was not enacted "quietly" (i.e., without notice or disclosure), as the Associated Press had published an article announcing "Oregon Medicaid to Cover Gender Reassignment" nearly a year earlier.

We've asked out HERC whether additional details are available to determine whether any 15- to 17-year-olds have been affected by the policy update or have undergone gender reassignment in Oregon following the change.

Last updated:    10 July 2015

Originally published:    10 July 2015

By Kim LaCapria

Kim LaCapria is a former writer for Snopes.

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Oregon Legislature Repeals Surgery Requirement for Gender Change on Birth Certificate

With Gov. Kitzhaber’s approval of HB 2093 yesterday, transgender people in Oregon will no longer have to show proof of surgery in order to change their birth certificates to accurately reflect their gender. Previously, Oregon law required surgery in order to update a birth certificate gender marker, even for those transgender people who did not need or want it, or were unable to access surgery for financial, medical, or other reasons. The ACLU supported the great work of agency and advocate partners to reach this victory. We are glad to see Oregon’s legislature and governor sign off on this important change and advance the rights of transgender Oregonians.

In 2011, the ACLU LGBT Project and the ACLU of Oregon submitted a friend-of-the-court brief on behalf of a transgender woman who was seeking to update her birth certificate but unable to afford surgery. The Linn County Circuit Court later cited our brief in finding the surgery requirement unconstitutional. That case allowed one individual to amend her birth certificate without surgery, but today’s legislation was necessary to fix the problem statewide. The change will take effect January 1, 2014.

Gender identity is a person’s psychological identification as male or female, which for transgender people may differ from that person’s anatomical sex. When an individual transitions his or her gender to better align these two things, that individual’s transition and treatment aim to permit him or her to participate fully and comfortably in society in the gender role with which he or she identifies. While medical treatments, including surgery, are critical to a healthy transition and medically necessary for many transgender people, medical authorities recognize that each transgender person’s specific course of treatment must be determined on an individual basis with the patient’s physician.

Surgery is not a universally required or prescribed aspect of gender transition for every transgender person. Many public and private insurance carriers have historically refused to cover gender-transition-related surgical procedures, leaving them out of reach even for those patients who do need them unless and until those individuals can save or raise tens of thousands of dollars. Whether a transgender person has had surgery is irrelevant to determining his or her gender. And yet, for decades Oregon law has required that transgender individuals seeking to obtain accurate birth certificates undergo costly surgical procedures without regard for whether they wanted or had any medical need for the surgeries.

The ability to obtain correct gender markers on their birth certificates is a right that many Americans take for granted. People often have to show their birth certificates in a variety of situations, from enrolling in school or the military to starting a new job or applying for another form of identification like a driver’s license or passport. Lacking access to accurate birth certificates has stigmatized transgender Oregonians and put them at serious risk of harassment and discrimination.

Long overdue, HB 2093 aligns Oregon law with well-established medical standards. It promotes fairness and equality and makes life easier for transgender people born in Oregon.

Learn more about transgender discrimination and other civil liberties issues: Sign up for breaking news alerts , follow us on Twitter , and like us on Facebook .

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Oregon lawmakers advance bill on abortion, trans health care

FILE - The Oregon state Capitol is seen in Salem, Ore., on Jan. 11, 2018. Oregon’s state House has approved a wide-ranging bill that would expand access to abortion and gender-affirming health care for transgender people. The bill passed along party lines Monday night, May 1, 2023, with Democrats voting in favor and Republicans against. (AP Photo/Andrew Selsky, File)

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SALEM, Ore. (AP) — Oregon lawmakers have advanced a sweeping bill intended to protect abortion and gender-affirming health care for transgender people by boosting legal safeguards and expanding access and insurance coverage.

Democratic representatives on Monday night passed the bill along party lines in a House floor vote that stretched for roughly six hours after Republicans sought to stall it.

Citing concerns about the wide-ranging scope of the bill — which addresses topics from minors’ access to abortion to emergency contraception at university student health centers to insurance coverage for gender-affirming care procedures — Republicans sought through various motions to send the bill back to different policy committees, delay the vote until next month and postpone it indefinitely.

Republican state Rep. Lily Morgan was among those who spoke in favor of its postponement.

“It would give us the time to address some of the concerns brought up today, and if nothing else have an honest discussion around them,” she said.

Republicans said they were frustrated that the bill, which has sparked fervent debate, only received one public hearing. The emotionally charged hearing at the state Capitol in Salem in March lasted several hours with dozens of people testifying in person. Hundreds more submitted written testimony both for and against it.

Democrats said the bill has been drafted over the past year and came out of a work group that was convened after the Supreme Court overturned the Roe v. Wade decision.

“This bill is the result of a year-long collaboration between dozens of legislators and stakeholders including patients, providers, advocates, community groups, and legal experts. It protects, strengthens, and expands safe, equitable access to reproductive and gender-affirming care—no matter who you are, where you live, or how much money you make,” Democratic Speaker Dan Rayfield said in a news release.

The bill would implement a wide-ranging series of measures, including shielding patients and providers from lawsuits originating in states where abortion and gender-affirming care are now restricted. It would also require public universities and community colleges with student health centers to provide emergency contraception and medication abortion.

Additionally, it would expand insurance coverage for gender-affirming health care by barring insurers from defining as cosmetic procedures that are prescribed as medically necessary for treating gender dysphoria, among other things.

The parts of the proposal that have proved to be the most contentious have to do with minors. Under the legislation, doctors would be allowed to provide an abortion to anyone regardless of age, and it would bar them in certain cases from disclosing that to parents.

Democratic lawmakers have said such scenarios are rare. But critics said this could exclude parents from key aspects of their child’s health care.

Abortion remains legal at all stages of pregnancy in Oregon, and state law already bars health insurance companies from discriminating on the basis of gender identity. But Democratic lawmakers said the measure was needed to push back against the flurry of anti-abortion and anti-LGBTQ+ measures in conservative legislatures that is compelling people to travel to states like Oregon in search of such care.

The bill now heads to the state Senate, led also by Democrats, where it could be voted on as early as this week.

Bill to expand protections for Oregonians’ gender identity clears Oregon Senate

House Bill 3041 separates definition of “gender identity” from “sexual orientation” and adds it to state laws addressing protections against discrimination.

A bill seeking to provide further protections for Oregonians based on gender identity is headed to the desk of Oregon Gov. Kate Brown following a 21-8 bipartisan vote in the Senate Monday.

House Bill 3041, which was approved 52-0 by the House back in April, amends Oregon statute to separate the definitions of gender identity and sexual orientation, and adds “gender identity” to all laws referencing sexual orientation. That includes broadening provisions of state statute added by the 2007 Oregon Equality Act which made it illegal to discriminate based specifically on the term “sexual orientation.”

The new law defines “gender identity” as an individual’s gender as it relates to their identity, appearance and behavior regardless of how that differs from a gender they were assigned at birth.

According to Sen. Kate Lieber, D-Beaverton, the purpose of the bill is to allow state law to take into consideration the nuances and differences between sexual orientation and gender identity, and to acknowledge those differences. Lieber also noted that the bill resolves conflicts within HB 2534 regarding discriminatory language in governing documents of condominium and homeowner’s associations by expanding protections to include gender identity.

“As an attorney, I know the importance legal clarity has on lived experience, and as the second LGBTQIA+ member and first openly gay state senator, I’m proud to carry this bill during pride month,” Lieber said.

The measure prompted several questions from Senators and a nearly 30 minute discussion about the bill’s potential impacts.

Sen. Bill Hansell, R-Athena (Umatilla County), rose to ask Lieber how the bill might impact school sports.

“How does this bill affect that if a male identifies as a female, a biological male born that way as a female, are they allowed to compete in high school meets against women?”

Lieber said she appreciated the question, but said the law has more to do with acknowledging that Oregonians have the right to choose how they identify themselves and respecting that, no matter what gender they’ve been assigned.

“I do believe that it’s important for all of us here to understand that a person who fully believes that they do not belong in the body they were assigned to at birth; that is a really real and difficult thing to do. And giving them every opportunity to express themselves in the body they feel that is theirs, even in athletics, is incredibly important for their self esteem and how they feel about themselves,” Lieber said. “So I would just say thank you for that question, but I believe we should be supporting these, many times younger people, who are making these very difficult decisions and really feel they’re in the wrong body.”

Hansell said he felt HB 3041 didn’t address his concerns surrounding allowing “male self-identified females” to compete in female athletic competitions, and for that reason he opposed the bill.

Sen. James Manning, Jr., D-Eugene, spoke in support of the bill, drawing on his experience as a drill sergeant in the United States Army where he said he often saw women physically outwork and outperform men.

“This is more of, what is the right thing to do, versus a challenge about gender issues,” Manning said.

Sen. Elizabeth Steiner Hayward, D-NW Portland, attempted to explain for her colleagues the very intentional and tough decisions that families raising children who have realized they’ve been assigned a gender that doesn’t represent who they are as a person. She also pointed out that as these situations become more prevalent, you will hear of the anecdotal events of someone born male who now identifies as female competing against women and “winning occasionally.”

“I think those are really going to be the exception, and to not protect all the other people who identify as trans through an important bill like this because of a rare situation, feels a bit like throwing the baby out with the bathwater,” Steiner Hayward said.

Sen. Sara Gelser also spoke about her first experience speaking to and learning about the experiences of transgender youth and how that impacted her view on such issues. Gelser said the bill is important because it recognizes the lived experience of people who have had challenging journeys, from being uncomfortable in their own bodies to transitioning into whom they feel they are inside, are both powerful and monumental.

“This bill does not change anything about sports, or healthcare, or clothing or driver’s licenses,” Gelser said. “The only thing that this bill does is eliminate an ambiguity and recognize how far we’ve come in terms of really recognizing the importance of identifying gender identity.”

Sen. Kayse Jama, D-SE Portland, said in his nonprofit work with the group Unite Oregon, he’s had the pleasure of meeting many people who either identify as gender nonconforming or a gender identity other than what they were assigned at birth. His experience is that people are who they are, and he supports HB 3041 because it seeks to codify that right for all Oregonians.

“We should be affirming that notion,” Jama said. “I’ve worked for many years making sure that Oregon is inclusive for all. What this bill does is, whether we talk about sports, or healthcare or other issues, really what it does is affirm somebody’s identity of who they really are.”

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Gender reassignment surgery is now available to oregon minors without parental consent.

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The topic of gender has been much discussed recently, especially with the high-profile case of Bruce Jenner transitioning to Caitlyn Jenner. It’s a very hot-button topic and will probably become even more so once the political debates of 2016 get into full swing.

Gender dysphoria is defined as the condition of feeling one’s emotional and psychological identity as male or female to be opposite to one's biological sex. Though there aren’t any major numbers stating just how many people have gender dysphoria, it is well known that struggling with one’s identity can be a burden not just for the one struggling, but for friends, family, classmates, colleagues, and more.

In Oregon, a controversial new law has been in place since the beginning of 2015 that has left residents of the seemingly forward-thinking state stunned.

Gender reassignment is a procedure that Bruce Jenner underwent to complete his transformation from male to female. While he is a consenting adult, the new law in Oregon allows for minors as young as 15 to get the surgery, even without consent from their parents.

Health Evidence Review Commission (HERC) was petitioned by Jenn Burleton, co-founder of the Portland-based Trans Active Gender Center, to include sex change operations, cross-sex hormone therapy, and puberty-inhibiting medications in the covered procedures for the management of individuals with gender dysphoria. The HERC 12-member panel includes doctors and medical professionals, all of whom are approved by the governor. The change to cover the procedures was settled in January without public debate.

The age of medical consent in Oregon is 15, but how far that consent goes depends on the topic. At 15, teens in Oregon are able to, without their parent’s consent, have sex, receive birth control, take a pregnancy test, and get an abortion. Conversely, according to an article published by IJ Review , 15-year-olds are unable to smoke cigarettes or marijuana, drive alone, send or receive sexts, vote, work more than 18 hours a week, drink, eat unhealthy foods at school, get tattoos, administer aspirin at school or use a tanning bed.

While the new law is very controversial, advocates for it state that it can help reduce suicides in teens with gender dysphoria. When questioned for more information about how many teens have enrolled in the program or how much it would cost the state, HERC distributed a frequently asked questions sheet/fact sheet . It details the background, criteria, medical evidence and what, why and how HERC came about their decision to cover procedures under the new law.

The sheet also states that, although they are certainly able to, at the time of the fact sheet’s publishing, zero teens and 10 adults under the Oregon Health Plan have undergone sex reassignment surgery.

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New rules proposed for licensing electrologists, increasing gender affirming care access

New proposed electrology rules in Oregon seek to reduce barriers to becoming a licensed electrologist, to reduce the wait time of up to two years for hair removal for transgender individuals seeking gender reassignment surgery.

There are about 78 licensed electrologists in Oregon, and there are no electrology schools currently taking new students.

The new rules would allow for a new route to licensure through a 600-hour electrology training program at any licensed body art facility. Trainees would have a temporary license while working directly under an approved supervisor.

The rules also would make it easier for individuals licensed in other states to obtain an Oregon electrology license.

Transgender individuals seeking gender reassignment surgery typically first get hair removal before surgical procedures. But there is a one to two year wait for such electrolysis in Oregon because of the lack of providers, according to the proposal document.

Medicaid began allowing coverage for gender affirming healthcare in 2015, but with the lack of electrology providers in Oregon, finding one who takes Oregon Health Plan can be another barrier for some, said Seth Johnstone, transgender justice program manager at the health care advocacy organization Basic Rights Oregon.

In early 2022, Basic Rights Oregon , as well as electrology professionals and individuals seeking gender reassignment surgery, asked the Health Licensing Office and the Board of Electrologists and Body Art Practitioners to find ways to reduce barriers to accessing electrolysis.

A temporary order was issued in April 2022 allowing electrologists licensed in other states to practice in Oregon if the licensing examination they took was comparable to Oregon’s.

A hearing was held on Wednesday for public comment on the new proposed rules.

Multiple current providers attended, some saying there should be strict guidelines on the qualifications for becoming a supervisor for the proposed training program.

One current electrologist suggested supervisors have a minimum of five years of post-licensure work experience. She worried that rushing into this program would “take away from the integrity of the profession.”

Anyone wishing to provide comment on the new proposed rules can do so through noon Jan. 28 by emailing Samie Patnode at [email protected] or by mail at Attn: Samie Patnode Health Licensing Office, 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192

Transgender health care

For many transgender individuals getting gender reassignment surgery is a part of the care they need to affirm their sense of self and increase their sense of safety, said Johnstone.

“Leaving your home and not being able to look like your authentic self puts you in danger,” said Johnstone.

Without hair removal prior to gender reassignment surgery, people can face complications including infection and pain, so electrolysis is usually the first step. Some trans and non-binary people also seek electrolysis for facial hair removal, which is another form of gender affirmative healthcare.

About 80% of gender diverse male sex assigned at birth people in Oregon want hair removal services, according to a survey done in 2021 by Basic Rights Oregon. Some 43% of people using private insurance had received these services at the time of the survey, while 22% of those using Medicaid had received services.

Kate Kauffman, owner of Brave Space , a transgender and non-binary resource center and advocacy organization, said many clients who receive counseling talk about the stress of barriers to accessing hair removal. Not being able to access this care can increase anxiety and gender dysphoria in a gender diverse individual, Kauffman said.

“It is a poor use of mental health funding to address the issues of physical health care,” said Kauffman. “Better applying this funding to the right avenue to treat gender dysphoria would save the health insurers money in the long run.”

Sydney Wyatt covers healthcare inequities in the Mid-Willamette Valley for the Statesman Journal. Send comments, questions, and tips to her at [email protected] , (503) 399-6613, or on Twitter @sydney_elise44

The Statesman Journal’s coverage of healthcare inequities is funded in part by the M.J. Murdock Charitable Trust , which seeks to strengthen the cultural, social, educational, and spiritual base of the Pacific Northwest through capacity-building investments in the nonprofit sector.  

Transgender Health Program

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Transgender Health Program: Insurance Information

OHSU clinics accept many kinds of insurance, including the Oregon Health Plan and many Medicare plans. Some services require prior authorization and referrals.

If you have insurance

Many insurance plans cover some transition-related services. Oregon requires health insurers to cover medically necessary treatments related to gender dysphoria if those treatments are covered for other conditions.

Private insurance

Check your member handbook or call the member services number on your insurance card to find out what may be covered.

Terms to look for: Gender dysphoria, gender identity disorder, sexual/gender reassignment or transgender health.

Oregon Health Plan

The Oregon Health Plan covers hormone therapy and some surgical services for transgender and gender-nonbinary patients. Talk to your health care provider and coordinated care organization to find out what services they may provide.

Learn more:

• The Oregon Health Authority has information about Oregon Health Plan benefits .

For patients

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Employer-provided benefits

If you get health insurance through your job, you should have a summary of benefits. Talk with your company’s benefits specialist or human resources manager about what’s covered.

If you don’t have insurance

Choosing a plan.

Oregon Health Plan: The Oregon Health Plan is the state’s Medicaid program for low-income people. You can apply online if you haven’t already been denied coverage.

Individual marketplace: HealthCare.gov , run by the federal government, helps you shop for and enroll in affordable health insurance. What you pay is based mostly on your income. You can enroll early November through mid-December or after certain life-changing events, such as losing your previous health insurance.

Medicare: This federal program is for people 65 and older and certain younger people with disabilities. Medicare.gov can help you find a plan.

Senior Health Insurance Benefits Assistance Program: This Oregon network of trained volunteers helps Medicare patients of all ages get coverage.

Seniors and People with Physical Disabilities Offices: This Oregon agency , a branch of the Department of Human Services, can help you find services.

Find an agent or application assistant: Visit the Oregon.gov help page to find someone near you to help you find the right coverage.

Help from health insurance agents and Medicare agents is free, but some insurance agents get a commission for recommending an insurer’s plan. For free unbiased help, look for Medicare volunteers and community partners on the Oregon.gov help page.

Recommended community partners: These organizations have expertise in transgender and gender-nonconforming health:

• Cascade AIDS Project offers help to anyone.
• Outside In , which helps homeless and marginalized youths, has a trans services coordinator: 503-535-3828 .
• Project Access Now helps vulnerable communities access health care.

What to ask

These questions can help you decide on an insurance plan, according to the Strong Families Network:

What is covered? When talking to customer service representatives, ask for the “Evidence of Coverage” or “Certificate of Coverage,” a full list of covered benefits for the plan.

What’s not covered? Pay attention to services or treatments specified as exclusions or limitations.

What’s covered for non-trans patients? If hormone therapy, chest surgery and hysterectomies are covered for anyone on the plan, they should be covered for transgender and gender-nonbinary members. In Oregon, it is illegal for insurers to cover services for some people and deny them to others.

Are there hormone therapy co-pays? If so, how much are they? Is there a limit on hormones or hormone injections? If so, what is it?

Is my health care provider covered by the plan ? Check whether your doctor is in the plan’s network.

Is there a network of trans-friendly doctors with training in gender-diverse care? If you want to find a gender-affirming provider,  GLMA: Health Professionals Advancing LGBT Equality  can help. Once you identify someone, ask which plans work with the provider.

Other questions to ask:

• Are there doctors within 30 miles who can serve trans and gender-nonbinary patients?
• Are mental health services available for gender-diverse people and their families, and are visits for gender-related needs covered?
• What kinds of documents are needed to receive services?
• Do I need to change my legal ID to get coverage as a person who is trans-identified?
• Are procedures such as facial gender-confirmation surgery covered?

Dealing with claims

These tips can help you navigate the claims process with your insurer:

• If your insurance is through your employer, contact your company’s benefits specialist or human resources manager.
• Have an advocate nearby or on call, ready to help you handle the stress.
• Be prepared to be misgendered. Many insurance companies don’t train their call-center staff on etiquette for transgender and gender-nonbinary patients.
• Have your group number, plan number and, if you have an online account with your insurer, your username and password.
• Research your plan and be prepared to explain your benefits package. Know what’s included and excluded. Call-center staffers don’t always distinguish well among the insurer’s various plans.
• You may need to ask for a supervisor. Be patient and polite, and remember they’re humans on the other end of the line.
• If you’re told you need a certain form, ask to have a blank copy emailed to you. Use the company’s name for any form, which can help representatives work faster.

These tips can help:

• Don’t despair. You can appeal.
• If you get an operator who can’t help, calmly ask for someone else.
• Don’t accept partial payment. A partial payment can be appealed.
• If you’re insured through work, ask your human resources manager or benefits specialist for help.
• If your employer has a policy on nondiscrimination, inclusion and diversity, you can use it to appeal.
• Find out if your plan has an explicit policy on parity.
• Some claims are denied more than once, even when a procedure is covered.
• If your doctor or benefits specialist finds a successful appeal for the same procedure, remove identifying information and include it with your appeal. This can help you avoid multiple denials.

OHSU resources

Visit our Billing and Insurance page to find:

• Information about our billing process
• Hospital costs
• Numbers to call if you need help
• Answers to frequent questions
• Information about financial assistance

Oregon resources

The Oregon Department of Consumer and Business Affairs has information about finding insurance, getting help paying for it, and your rights.

Request services

Please fill out an online form:

• I am seeking services for myself.
• I am seeking services for someone else.

Other questions and concerns

Contact us at:

• 503-494-7970
• [email protected]

What is gender-affirming care?

Most broadly stated, gender-affirming care is care that respects and validates a transgender, non-binary, or intersex person’s experience. In terms of accessing transition-related treatment, gender-affirming care refers to interventions that support people in their gender transition. 

Click on a link below to view our gender-affirming care handout:

• Traditional Chinese
• Simplified Chinese

What type of gender-affirming care does CareOregon cover?

CareOregon’s coverage includes medically-necessary transition-related healthcare as established by the Oregon Health Plan and House Bill 2002 . These services include coverage for puberty suppression, primary care and specialist doctor visits, mental health care visits, hormone therapy, electrolysis, top surgery, bottom surgery, body contouring, facial gender confirmation surgery, lab work, and more. 

Click on the arrows below for dropdown lists of covered medical and surgical services. If you have questions or don't see your desired care listed, please call Customer Service at 503-416-4100 , toll-free 800-224-4840 (TTY 711 ) for additional information. Please note: s ome services may require prior approval. 

Medical care

• Hormone therapy
• Puberty blockers
• Hormone blockers
• Mental health therapy, including letters of support
• Electrolysis
• Surgical site hair removal
• Pre-and post-surgical pelvic physical therapy
• Speech therapy
• Medical tattooing

Surgical care

• Mastectomy & chest reconstruction/reduction
• Breast augmentation & mastopexy
• Urethroplasty
• Orchiectomy
• Phalloplasty
• Metoidioplasty
• Scrotoplasty
• Penile & testicular implants
• Scrotectomy
• Nullification surgery
• Clitoroplasty
• Vaginectomy
• Vaginoplasty
• Vulvoplasty
• Hysterectomy
• Salpingo-oophorectomy
• Facial gender confirmation/facial feminization surgery
• Tracheal shave
• Body contouring
• Surgical revisions

Where can I find gender-affirming care?

CareOregon contracts with many licensed behavioral health professionals, primary care doctors, specialists (such as endocrinologists), and surgeons who can provide gender-affirming care.

Gender-affirming care providers, those with experience and training in working with people who are a wide variety of genders, can be found in the lists below.

Please note:

• These lists are updated quarterly and are current as of October 2023.
• For security, some providers go by first name only.
• Many behavioral health providers offer services statewide.

County codes: Clackamas = CL; Multnomah = MU; Washington = WA

Multnomah county

Provider Name

Owl's Nest North Therapy Joint

Credentials

503-281-1166

André Pruitt

503-860-1213

Rustic Sage, LLC

Madeline Harmon

503-444-8214

Madeline Harmon | Sankofa Counseling

LaTrece Gaither

LaTrece Gaither | Sankofa Counseling

Vanessa Washington

Vanessa Washington | Sankofa Counseling

503-662-2808

Nature Abundance

Madilyn Long

971-264-0944

Madilyn Long, MSW, LCSW | Seasons Mental Health and Wellness

Elisia Lopez-Mendiola

971-910-8918

Elisia Lopez-Mendiola | Healing Tides Counseling

Nohemi Robles Hernandez

she/her/ella

Nohemi Robles Hernandez | Healing Tides Counseling

Leah Gregory

Leah Gregory | Healing Tides Counseling

Kian Kolahi

Kian Kolahi | Healing Tides Counseling

Maddison VanderHoff

Maddison VanderHoff | Healing Tides Counseling

Talle Selhorst

Talle Selhorst | Healing Tides Counseling

S. Devoll | Healing Tides Counseling

Matthew Lucas

503-567-9317

Matthew Lucas, MSW, CSWA | Pulse Wellness

Ian Schroeder

LPC, CADC III

503-445-7699

Ian Schroeder | Prism Health

Katya Ludwig

971-319-4827

Katya Ludwig | Sprout Therapy PDX

Noa Grayevsky

503-765-5733

Noa Grayevsky, MA, QMHP | Full Spectrum Therapy

Aleks Taylor

LPC Associate

Aleks Taylor | Full Spectrum Therapy

Quinn Connick

Quinn Connick | Full Spectrum Therapy

Chloe Jacobson

Chloe Jacobson | Full Spectrum Therapy

Julie Cloutier

Julie Cloutier | Full Spectrum Therapy

Dave Eccles

Dave Eccles | Full Spectrum Therapy

Oriol Zemko

FNP-BC, MSN

Oriol Zemko | Full Spectrum Therapy

Gabby Hancher

Counseling Practicum Student

Gabby Hancher | Full Spectrum Therapy

Eli Cuda | Full Spectrum Therapy

Gracen Tichelaar

Gracen Tichelaar | Full Spectrum Therapy

Del Likins | Full Spectrum Therapy

Jenny Lee | Full Spectrum Therapy

Kayla Daniels

LCSW, CADC I

Kayla Daniels | Prism Health

Mattie Boucher

Mattie Boucher | Prism Health

Andrew Decker

Andrew Decker | Prism Health

Chance Hessel

Chance Hessel | Prism Health

Rain Estrada

503-476-1068

Deirdre Rundle

503-300-1941

Lodestar Mental Health Services, LLC

Vivi Nguyen

503-486-8936

Vivi Nguyen | Brave Space

LCSW, CADC II

Tara Rose Therapy

Quinn Rivenburgh

MAAT, ATR-BC, LAT, LPC

Quinn Rivenburgh | Portland Therapy Center

Elise Himes

971-270-0167

Elise Himes | Health Allies Counseling

Alyssa Nagel

Alyssa Nagel | Health Allies Counseling

Jack Marvin

503-974-6885

Jack Marvin | Portland Therapy Center

Sasha Strong

MA, PhD, LPC

971-279-7261

Sasha Strong, MA, PhD, LPC | Portland Therapy Center

Sid Napier, MS | Full Spectrum Therapy

ATR, LAT, LPC

Sam Skye | Portland Therapy Center

Kaspar Woods

Kaspar Woods | Brave Space

Anna Cullop

503-568-1499

Anna Cullop, LPC | Cocoon Counseling Services

Colette Gordon

503-780-4169

Colette Gordon | Do It Together Counseling

971-200-5254

Kat Canada, LCSW | Portland Therapy Center

River Fagan

503-917-4768

Dragonwise Counseling and Consulting

Casey Granbois

503-622-8964

Casey Granbois, MSN, PMHNP | Portland Mental Health and Wellness

Jake Balinky

Jake Balinky | Portland Mental Health and Wellness

Trevor Rachko

503-460-0405

Trevor Rachko | Bridge City Family Medical Clinic

Eva Cicilian

Eva Cicilian | Bridge City Family Medical Clinic

Kyle Anderson

Kyle Anderson, PMHNP | Bridge City Family Medical Clinic

Nate Bagley

503-954-2188

Nate Bagley, MA, LPC | Bridge City Family Medical Clinic

971-301-4229

Chris Doud, CSWA | Spectrum Counseling

Rebekah Lubeck

503-260-8612

Rebekah Lubeck, MSW, LCSW | Pulse Wellness Cooperative

Rosanne Marmor

503-936-1924

Rosanne Marmor, MSW, LCSW | Pulse Wellness Cooperative

971-266-4291

Lola Ryan, MSW, LCSW | Pulse Wellness Cooperative

Online contact form

David | Sakura Counseling

Katie | Sakura Counseling

Taryn | Sakura Counseling

Summer | Sakura Counseling

Nancy | Sakura Counseling

Grace | Sakura Counseling

Kelsey | Sakura Counseling

Myra | Sakura Counseling

Clark Hazel

Clark Hazel, LCSW

Jennie FreimoEller

971-361-8303

Stephanie Tolentino

LMFT Associate

Riley Kastenhuber

LMFT Intern

Paris Courtney

Maia Bellavia

Jamie Brkowitz

Elizabeth Knutsen

Melisa De Seguirant

Danielle Walker

Keely Helmick

Cal Reynolds

503-545-6798

Link Therapy

Lacy Cooper

Myra Bazell

503-281-0308

Hands On Medicine

Diana Frates

Claire Tam | Full Spectrum Therapy

Caitlin O'Dell

503-954-2188x19

Caitlin O'Dell M.ED., LMFT | Bridge City Counseling

April Nunez

April Nunez, LMFT | Health Allies Counseling

Brilliancy Counseling

Kaylynne Gray

Kaylynne Gray | Full Spectrum Therapy

Kristen Cole

Kristen Cole | Full Spectrum Therapy

Full Spectrum Therapy

Cole Prophet

Cole Prophet | Full Spectrum Therapy

Vivi Langdon

Vivi Langdon | Full Spectrum Therapy

Sam C. Skye | Full Spectrum Therapy

Sarah Abramovitz

ATR-BC, LCAT, LPC

Sarah Abramovitz | Full Spectrum Therapy

Kaspar Woods | Full Spectrum Therapy

RYT, QMHP-R

Katie Wood | Full Spectrum Therapy

Bridge City Counseling

Monica Melgar-Sharman

Washington county

503-444-8230

Amy Beene, LPC | NW Counseling Associates, LLC

Clackamas and Washington counties

Regina Vander

503-303-0304

Regina Vander, LCSW | A Healing Intention

Jenna Urban

Jenna Urban | A Healing Intention

Sara Amundson

Sara Amundson | A Healing Intention

Destiny Bankhead

Destiny Bankhead | A Healing Intention

Elizabeth La Torella

Elizabeth La Torella | A Healing Intention

Jessica Farrell

Jessica Farrell | A Healing Intention

Jean Phare | A Healing Intention

Cherity Whiteaker

Cherity Whiteaker | A Healing Intention

Andy Vogler

Andy Vogler | A Healing Intention

Clackamas, Multnomah and Washington counties

Dmitri Dosamantes

503-545-2572

Dmitri Dosamantes | Portland Therapy Center

Megan Lester

503-517-8663

Catholic Community Services

Davonna Wilson

ARNP, PMHNP

971-352-6971

Davonna Wilson, PMHNP | Mindful Therapy Group

Clackamas county

LPC, CADC II

503-722-6588

Behavioral Health Division | Clackamas County

Nadine Luensman

360-980-8562

Portland Therapy Center

Arielle Ross

[email protected]

Wandering & Belonging Therapy

Margot Presley

971-361-7700

Pat Buckley

503-228-4533

Richard Bruno

MD, MPH, FAAFP, FACPM, AAHIVS

Wendy Vannoy

971-380-0121

Dr. Wendy Vannoy

Sean Peter Horan

503-236-4580

A Balanced Life Health Care

Suzanne Scopes

503-230-0812

Dr. Scopes Natural Healthcare

Angela Carter

503-459-2584

Dr. Angela Carter, ND

Connie Silverman

Connie Silverman, DNP, FNP-C | Prism Health

Ben Sokoloff

Ben Sokoloff, DO, AAHIVS | Prism Health

Rian Johnson

Rian Johnson, MN, FNP-C | Prism Health

Amy Wiser, MD, FAAFP | Prism Health

Maeve McGarry

Maeve McGarry, DNP, FNP | Prism Health

Elizabeth Yiu

Elizabeth Yiu, MSN, FNP-C | Prism Health

Rachel Jackson

503-535-3800

Rachel Jackson, MD | Outside In

PNP, MSN, MS, RN

Diana Hall, PNP, MSN, MS, RN | Outside In

Emmy Wohlgemuth

Emmy Wohlgemuth, FNP-C, CNM | Outside In

Isabelle Trepiccione

Isabelle Trepiccione, MD | Outside In

Karletia Lewis

503-287-4932

Karletia Lewis, FNP | North by Northeast

Karlyn Nieland

Karlyn Nieland, ANP | Outside In

Mandi Ruscher

MSN, FNP-C, CPEN

Mandi Ruscher, MSN, FNP-C, CPEN | Outside In

Meghan Brinson

Meghan Brinson, ND | Outside In

Miguel Mitchell

Miguel Mitchell, ND | Outside In

Shelda R. Holmes

Shelda R. Holmes, FNP | Hands On Medicine

Kim Kelsey, FNP | Hands On Medicine

Melanie Anthony

Melanie Anthony, FNP | Hands On Medicine

Teri Bunker

Teri Bunker | Bridge City Family Medical Clinic

Gwyneth Jones

Gwyneth Jones | Bridge City Family Medical Clinic

Brittany Kolluru

Brittany Kolluru | Bridge City Family Medical Clinic

Amber Oyama

Amber Oyama | Bridge City Family Medical Clinic

Healthy Living Community

971-438-6112

Ruth Christiansen

503-494-9992

Ruth Christiansen PA-C | OHSU

Dr. Jackson

ND, LMT, CPT

503-882-0752

Dr. Jackson | Sirona Integrated Health

Michelle Williams

Michelle Williams | Sirona Integrated Health

Emily Rose Jacobson

503-418-3900

Emily Rose Jacobsen PA-C | OHSU

Megan Brusca

503-249-1900

Megan Brusca, MD | Broadway Medical Clinic

Darcie Clark

Hands on Medicine

Zannah Martell

Stephen Levy

ND, LAC, LMT

503-831-8116

Soaring Health & Wellness

Planned Parenthood NE Portland Health Center

888-875-7820

Planned Parenthood

Planned Parenthood Hillman East Portland Center

Tove Silver

503-848-5861

Tove Silver | Neighborhood Health Center

Megan Manley

503-352-6000

Virginia Garcia Beaverton Wellness Center

Lisa Kipersztok

Ericka Horner

503-359-4773

Mountain View Medical Center

Planned Parenthood Beaverton Health Center

Telehealth only

Oshin Worthington

503-610-3828

Oshin Medicine

PPSO Telehealth Services

541-344-9411

Planned Parenthood Milwaukie-Oak Grove Health Center

Multnomah and Clark counties

Dr. V Madrigal

MU & Clark (Washington)

503-850-8216

Dr. Venessa Madrigal | Teyolia Natural Medicine

Kaiser Permanente Gender Pathways Clinic

503-249-6748

Northwest Gender Pathways Clinic

503-400-6622

Dr. Tina Jenq, MD | Oregon Cosmetic and Reconstructive Clinic

Tuan A. Nguyen

MD, FACS, DDS

503-635-1955

Lake Oswego Plastic Surgery

503-239-6800

Oscar Polo, MD, FACOG | The Oregon Clinic

503-494-6687

Jens U. Berli, MD | OHSU

Daniel Dugi

503-346-1500

Daniel D. Dugi, III, MD, FACS | OHSU

503-612-5260

Megan Bird, MD | Legacy

Hema Thakar

503-413-4992

Hema Thakar, MD, FACS | Legacy

Jyoti Chouhan

Jyoti Chouhan, DO, PharmD, FACS | OHSU

Toby Meltzer

480-657-7006

Toby Meltzer, MD | Legacy

Richard McNally

503-488-2345

Richard S. McNally, MD | Providence

Juliana E. Hansen

Juliana E. Hansen, MD, FACS | OHSU

Nick Esmonde

Nick Esmonde MD | The Meltzer Clinic

Geolani W. Dy, M.D., F.A.C.S. | OHSU

Jennifer Franz

Jennifer Franz, MD, FACOG | The Oregon Clinic

Lishiana Shaffer

503-418-4500

Lishiana Shaffer MD | OHSU

Krista Jensen

503-413-7353

Krista Jensen, DO

Scott Hoffman

Scott Hoffmann, MD

Sean McNally

Sean McNally, MD, PhD | The Oregon Clinic

Michael Schmitt

Michael Schmitt, MD | The Oregon Clinic

Hetal Fichadia

503-488-2344

Hetal Fichadia, MD, FACS

Please note: These surgeons are only available to Health Share/Kaiser members.

Rahul Kasukurthi

503-652-2880

Rahul Kasukurthi, MD | Kaiser Permanente

Alexander J. Gougoutas

Alexander Gougoutas, MD | Kaiser Permanente

Hao-Jun J. Chong

Hao-Jun Chong, MD | Kaiser Permanente

Patricia H. Sandholm

Patricia Sandholm, MD | Kaiser Permanente

Jennifer A. Murphy

Jennifer Murphy, MD | Kaiser Permanente

Sara Spettel

503-297-1078

Sara Spettel, MD | Northwest Urology

Christopher Razavi

Christopher R. Razavi, MD | OHSU

Sasha Druskin

503-223-6223

Sasha Druskin, MD | Northwest Urology

Marcie Drury Brown

Type of care

Pediatric Endocrinologist

503-216-6050

Marcie Drury Brown, MD | Providence

Karmen Steffan

Voice therapy

971-346-0355

Breatheworks

Hair removal

619-922-9933

Auntie Claire's Permanent Hair Removal

Michelle Cappadona

Michelle Cappadona | OHSU

Jaimee T Bloom

503-224-3300

Portland Electrolysis & Skin Care

Kathryn Trosen

503-410-1751

Heather Onoday

Dermatology

RN, FNP, MN

503-418-3376

Heather Onoday, RN, MN, FNP | OHSU

Radhika Purushothaman

503-413-1600

Radhika Purushothaman, MD | Legacy Health

David Snyder

David Snyder, MD | Legacy Health

Sevket Yigit

Sevket Yigit, MD | Legacy Health

Kara Connelly

503-346-0640

Kara J. Connelly, MD | OHSU

Hayley Baines

Hayley Baines, MD | OHSU

Stephanie Tarlow

P.A.-C, C.D.C.E.S.

Stephanie Tarlow, P.A.-C, C.D.C.E.S. | OHSU

Rowan Everard

Acupuncture

630-297-3705

Inner Sanctuary Wellness

Gender Communication Lab

503-725-3070

Joshua Shindler

503-494-5947

Joshua S. Schindler MD | OHSU

The Wellness Group - Voice, Speech and Swallowing LLC

503-946-6907

The Wellness Group

Jackie Cano

Jackie E Cano MA | OHSU

Alice Berry

503-701-4900

Transformations Electrolysis LLC

Maya Hunter

Maya Hunter, MD | Legacy Health

Karin Selva

Karin Selva, MD | Legacy Health

Monte Nido - West Linn

Eating disorder residential treatment

888-228-1253

The Living Room 

Community center & peer support

503-825-2535

The Living Room

Prism Health

primary care, hormone therapy and mental health care clinic

Transgender Health Program - OHSU

Education, case management, community support

503-494-7970

The Equi Institute (previously Sacred Vessel)

Case management, community support, and peer support

The Equi Institute

Northwest Gender Pathways Clinic - Kaiser

Advocacy, community supprt

Contact form

Portland Two Spirit Society

Community support

Facebook page

Portland Two Spirit Society - Facebook page

TransActive Gender Center

503-768-6024

Lewis & Clark Graduate School TransActive Gender Project

Sexual & Gender Minority Youth Resource Center (SMYRC) - New Avenues for Youth

503-872-9664

The Q Center

503-234-7837

Me Cuido, Te Cuido Trainings - Familias en Accion

503-201-9865

Black and Beyond the Binary Collective

Education, community support, mutual aid

971-258-1713

The Queer Resource Center - Portland State University

Community center

503-725-3000

primary care and hormone therapy clinic

503-535-3860

Quest Center for Integrative Health

503-238-5203

gender-affirming voice and communication techniques

Website Intake form

True Colors Recovery

Community center & peer support, substance use recovery

online contact form

Mental Health & Addiction Association of Oregon

Peer support

503-922-2377

PDX Trans Housing Coalition

PDX Trans Housing Coalition - Facebook page

STRIDE (LifeWorks NW)

Peer support & case management

503-619-9007

LifeWorks NW Prevention Services

Doernbecher Gender Clinic (Pediatric) - OHSU

primary care, hormone therapy and mental health for gender diverse youth and families

Doernbecher Gender Services

Legacy's T-Clinic (Pediatric)

Randall Children's Gender Care Center

Rahab's Sisters

community gatherings, mental health support, street outreach

971-208-3176

Clackamas, Multnomah, Washington and Clark counties

Northwest Gender Alliance

CL, MU, WA, Clark Co

Community support & peer support

AFFIRM Groups

mental health support for youth

AFFIRM - Options Counseling and Family Services

Planned Parenthood Southwestern Oregon

Basic Rights Oregon

Advocacy organization

503-222-6151

Out Dance Project - Boom and Bust

Statewide and Clark county

Planned Parenthood Columbia Willamette

Statewide & Clark Co

888-576-7526

Beyond These Walls

Project HEAL

Eating disorder support

FEDUP Collective

The FEDUP Collective

Dem Bois Inc.

financial assistance to person(s) of color for gender affirming surgeries

Website intake form

Dem Bois website

What are the steps to accessing services?

1. start with your primary care and mental health providers.

They can help you with most everything from your initial gender dysphoria diagnosis to accessing hormone treatment and/or surgeries. In some cases, it is necessary to have a referral from a primary care provider and a mental health provider in order to schedule a consult for surgery. You can search for providers from the lists above or by calling Customer Service.

2. Familiarize yourself with medical interventions and what feels best for you

There are a variety of options available when it comes to hormonal and surgical interventions. Some surgeons in our network perform different surgeries and have different techniques they use for each. We recommend contacting a surgeon’s office to review surgery types, recovery timelines, considerations and risks, along with any other questions you may have. Please note that hormonal and surgical intervention for people under 18 is limited and additional screening may be required.

3. Determine if getting a diagnosis of what has come to be called gender dysphoria is appropriate or needed to access the care you want and if so, get it in writing

Be sure your gender dysphoria evaluation is from a mental health provider qualified to diagnose gender dysphoria. Clinicians with a minimum of a Master’s degree are eligible to write letters diagnosing patients with gender dysphoria for the Oregon Health Plan. These letters must be completed by a licensed clinician or an unlicensed clinician with a licensed clinical supervisor’s signature. These letters may be referred to as “assessment letters” or “letters of support” and are necessary for accessing surgery and, in some cases, changing your gender marker on identity documentation (e.g., birth certificate, state ID, etc.). Bottom surgeries require two assessment letters.

If you need help with accessing services, or if you want to talk to someone about the services CareOregon provides, call Customer Service at 503-416-4100 , toll-free 800-224-4840 or TTY 711 .

Additional CareOregon resources

CareOregon supports transition needs outside of medical interventions. Members and their care providers can request health-related services funds (HRSF)  for items or services that aren’t covered under standard Oregon Health Plan services, but will improve a person’s health. HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers.

Some examples of items that can fall under HRSF are:

• gender affirming clothing
• prosthetics
• costs related to name changes
• gender marker changes
• identity documentation

For more information, please visit our health-related services webpage .

Outside resources

Oregon Health & Science University (OHSU) Transgender Health Program

State and nationwide resources  

Oregon Health Authority GUIDELINE NOTE 127, GENDER AFFIRMING TREATMENT

OHSU Transgender Health Program's Resources for Youth, Adults, Families, and Allies

• 2023: Keep your OHP coverage
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Oregon lawmaker wants to bar transgender teenagers from sex reassignment surgery without parents' permission

• Updated: Sep. 17, 2015, 7:30 p.m. |
• Published: Sep. 17, 2015, 6:30 p.m.
• Casey Parks | The Oregonian/OregonLive

Marijuana committee agrees on early sales

Rep. Carl Wilson, R-Grants Pass, (right) listens at a June 25, 2015, meeting on implementing Measure 91. Wilson wants his fellow lawmakers to ban teenagers from using the Oregon Health Plan to pay for hormones or sex reassignment surgery without their parents' permission. Denis C. Theriault/Staff

(Denis C. Theriault/Staff)

An Oregon legislator wants lawmakers to bar 15-year-olds from using the Oregon Health Plan to pay for sex reassignment surgery.

No minors have yet used the state insurance to pay for such a surgery. But Carl Wilson , R-Grants Pass, said  a 2014 decision to offer Oregon Health Plan coverage for transgender-related medicines and procedures could allow teenagers to make life-altering decisions they will later regret. "We all remember what it's like to be 15," Wilson said. "Some of the decisions we were prepared to make in that time of our life, I'm really not sure we thought about the lasting implications of those things." LGBT advocates say Wilson's push is misguided: The age of consent for all medical and dental procedures in Oregon is 15, and excluding one procedure would be discriminatory. "This is deeply disappointing," said Jeana Frazzini, co-director at the LGBTQ advocacy group Basic Rights Oregon . "We believe that doctors, patients and families should be allowed to decide the best course of treatment on a case-by-case basis. There's no need to carve out an exception when the care is related to gender dysphoria." Oregon's state Medicaid began covering hormones and some surgical procedures this year after the state Health Evidence Review Commission , which examines medical research to determine the coverage priorities for Oregon Health Plan, deemed the treatments "medically necessary" for transgender Oregonians. The 2014 decision didn't specify an age limit, but Oregon's medical age of consent has been 15 since 1971. That means a 15-year-old can go to the doctor or the dentist, seek birth control or a root canal, all without a parent's OK. They can also agree to have surgeries. Wilson, the deputy House Republican leader, said he decided to introduce legislation after hearing from more than 50 "outraged" parents and grandparents. Wilson said his staff rarely hears from that many people. Only Senate Bill 941 , a 2015 legislation requiring background checks for private gun sales, inspired as many calls. His constituents said government officials had "overreached," Wilson said, in allowing teenagers to "go behind their parents' backs" to seek care. The age of consent has come under fire before: In 2012, after the Affordable Care Act guaranteed coverage of sterilization,  conservative activists worried 15-year-olds could be sterilized without their parents' knowledge. Wilson said he has heard advocacy groups such as Basic Rights mention the 2011 survey that showed 40 percent of transgender Oregonians have attempted suicide. The state review board agreed with doctors and activists who testified that coverage of hormones and some surgeries will reduce the rates of suicide, anxiety and depression for transgender patients. "While I do think that is a noble thing to consider," Wilson said, "the greater thing to consider here is if we let 15-, 16- or 17-years-olds do this without the knowledge of their parents, they might wind up waking up one day realizing they have made the mistake of a lifetime." He doesn't know if anyone in his district has used the benefit. He said he hasn't, as far as he knows, ever met a transgender person. So far, 10 adult patients have used Oregon Health Plan benefits to pay for surgeries including the removal of breasts and testicles, according to data kept by the Oregon Health Authority.

No patients younger than 17 have used the benefit to pay for sex reassignment surgery. More than 50 minors have used state coverage to pay for therapy related to gender dysphoria, the medical diagnosis for someone who is transgender. The coding for all 56 of those visits indicated that family members were involved, said Stephanie Tripp, a spokesperson for the Oregon Health Authority. Another 17 minors have used the state insurance to pay for hormone treatments or puberty-suppressing medications. Though Oregon law allows 15-year-olds to pursue sex reassignment surgery, surgeons can decide not to operate. "This isn't surgery on demand," Frazzini said. "It's a significant process with plenty of built-in safeguards." In Oregon, surgeons require several things before performing sex reassignment surgery on a patient. They ask for two letters from a licensed therapist. Some surgeons require patients to have been on hormones for a year. Doctors can also take into account whether a patient has family or friends' support to help during recovery. Wilson said he knows the treatments are not "walk-up service." "But if the government opens up an opportunity for something to happen," he said, "it will ultimately happen." Wilson said his legislation will only focus on taxpayer-funded procedures for teenagers. He won't challenge a teenager's right to use private insurance to pay for gender dysphoria treatment, and he won't immediately try to repeal the state coverage for adults. He hasn't talked with fellow legislators about the proposal, but he "trusts" they will support him. Frazzini said her organization will fight his legislation. "This is life-saving treatment for transgender Oregonians," Frazzini said. "If he does in fact propose legislation, we'll be there every step of the way to defeat it. We're working not only to advance policy but to defend our victories everywhere they're challenged." -- Casey Parks

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TLDEF's Trans Health Project

Oregon health authority (oregon health plan), prioritized list of health services - gender dysphoria/transsexualism.

Policy: Prioritized List of Health Services - Gender Dysphoria/Transsexualism Policy Number: Line 312 Last Update: 2020-11-09 Issued in: Oregon

This policy applies to Medicaid

Breast Reconstruction:

Mammoplasty (CPT 19316, 19324-19325, 19340, 19342, 19350) is only included on this line when 12 continuous months of hormonal (estrogen) therapy has failed to result in breast tissue growth of Tanner Stage 5 on the puberty scale OR there is any contraindication to, intolerance of or patient refusal of hormonal therapy. Sex reassignment surgery is included for patients who are sufficiently physically fit and meet eligibility criteria. To qualify for surgery, the patient must: A) have persistent, well documented gender dysphoria B) for genital surgeries, have completed twelve months of continuous hormone therapy as appropriate to the member’s gender goals unless hormones are not clinically indicated for the individual C) have completed twelve months of living in a gender role that is congruent with their gender identity unless a medical and a mental health professional both determine that this requirement is not safe for the patient D) have the capacity to make a fully informed decision and to give consent for treatment E) have any significant medical or mental health concerns reasonably well controlled F) for breast/chest surgeries, have one referral from a mental health professional provided in accordance with version 7 of the WPATH Standards of Care.

Facial Reconstruction:

Individuals have received coverage for facial gender confirmation surgery under the Oregon Health Plan.

Permanent Hair Removal:

Electrolysis (CPT 17380) and laser hair removal (CPT 17110,17111) are only included on this line as part of pre-surgical preparation for chest or genital surgical procedures also included on this line. These procedures are not included on this line for facial or other cosmetic procedures or as pre-surgical preparation for a procedure not included on this line.

Youth Services:

Hormone treatment with GnRH analogues for delaying the onset of puberty and/or continued pubertal development is included on this line for gender questioning children and adolescents. This therapy should be initiated at the first physical changes of puberty, confirmed by pubertal levels of estradiol or testosterone, but no earlier than Tanner stages 2-3. Prior to initiation of puberty suppression therapy, adolescents must fulfill eligibility and readiness criteria and must have a comprehensive mental health evaluation. Ongoing psychological care is strongly encouraged for continued puberty suppression therapy. Cross-sex hormone therapy is included on this line for treatment of adolescents and adults with gender dysphoria who meet appropriate eligibility and readiness criteria. To qualify for cross-sex hormone therapy, the patient must: A) have persistent, well-documented gender dysphoria B) have the capacity to make a fully informed decision and to give consent for treatment C) have any significant medical or mental health concerns reasonably well controlled D) have a comprehensive mental health evaluation provided in accordance with Version 7 of the World Professional Association for Transgender Health (WPATH) Standards of Care (www.wpath.org).

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Updated on Nov 20, 2020

Bill expanding abortion, gender-affirming care access moves forward in Oregon

A sweeping bill intended to expand access to abortion and gender-affirming care passed the Oregon House on Monday, despite Republicans' repeated attempts to block the measure.

The bill passed with a 36-23 vote after House members spent nearly 10 hours on the floor. House Speaker Dan Rayfield repeatedly urged Republicans to maintain proper decorum and stick to talking about the bill’s provisions.

The measure, Oregon House Bill 2002, would:

• Allow minors younger than 15 years old to get abortions without parental approval
• Expand state coverage of medical services for transgender individuals. Access to services to help reverse gender transition also would also be covered by the legislation after Republicans voiced concern for those wishing to de-transition after receiving gender-affirming care.
• Require state-regulated and Oregon Health Plan insurance coverage of "all medically necessary gender-related services that are prescribed in alignment with accepted standards of care."
• Repeal a statute that makes concealing the birth of a infant a misdemeanor. Democrats have described the statute as "antiquated," saying it came out of a desire to criminalize having sex out of wedlock.

The measure now heads to the state's Democratic majority Senate before going to Democratic Gov. Tina Kotek for her consideration.

“House Bill 2002 moves Oregon forward in our work to ensure a more just, equitable healthcare system by stopping politicians from interfering in personal medical decisions, closing gaps in insurance coverage, and increasing access to care,” said Rep. Rob Nosse, D-Portland, in his opening statement introducing the measure.

Abortion laws by state: Searchable database of state-by-state abortion limits and protections

How does Oregon House Bill 2002 compare nationally?

The reproductive-health and access-to-care bill has been a legislative priority for Oregon Democrats since the U.S. Supreme Court’s ruling in June left abortion access up to individual states. Republican-led legislatures nationwide have since introduced and, in some cases, passed more than 400 anti-LGBTQ bills limiting or blocking access to reproductive and gender-affirming care.

Oregon's bill also covers parental involvement laws for abortion access. Twenty-six states require parents' involvement in a minor’s decision to have an abortion, Rebecca Wang, legal support counsel at the reproductive justice organization If/When/How, told USA TODAY in February. Some require parental consent. Others only require that parents be notified. And four states — Wyoming, Utah, Virginia and Florida — require both, Wang said.

Many minors may fear parental involvement could have severe consequences, such as being forced to continue a pregnancy, abuse, loss of housing or economic support, and alienation from their families, Wang said. Others may be in the foster care system and may not have access to a parent who can give consent.

"We know that most young people who can involve a parent in their reproductive health decisions, do so," Wang said. "For young people who cannot, it's usually due to some challenging circumstances."

Follow Sydney Wyatt on Twitter @sydney_elise44 .

Oregon: 15-Yr-Olds Can Get Sex Change without Parental Consent – Covered under Medicaid

Citizens of Oregon have been alarmed by the slow realization of a new law implemented this past January that said 15-year-old boys and girls can get a sex-change operation without parental consent – the first law of its kind in the United States. 

The new law passed not by a ballot measure, or a legislative bill, or even judicial fiat, but by the Oregon Health Authority in conjunction with the Health Evidence Review Commission (HERC), who determined that since Oregon’s current age of medical consent stands at 15-years-old, then they should be allowed to get sex-change operations without interference.

“Age of medical consent varies by state. Oregon law – which applies to both Medicaid and non-Medicaid Oregonians – states that the age of medical consent is 15,” said Oregon Health Authority spokeswoman Susan Wickstrom

Under Medicaid, teenagers suffering from Gender Dysphoria, still a mental illness by the American Psychiatry Association, can receive “cross-sex hormone therapy, puberty-suppressing drugs and gender-reassignment surgery.”

However, the process in getting Oregon’s age of medical consent to somehow include such a controversial medical procedure, which receives coverage from Medicaid, has been quite dubious from the outset. According to Fox News, the HERC changed its policy on sex-change operations with zero public debate and were voted on by members “appointed by the governor and paid by the state of Oregon.” Furthermore, the Oregon Health Authority’s website shows the policy had been discussed at only four meetings in 2014 and passed with no opposition or concern about the potential damage this could have on teenagers. 

“It is trespassing on the hearts, the minds, the bodies of our children,” said Lori Porter of Parents’ Rights in Education. “They’re our children. And for a decision, a life-altering decision like that to be done unbeknownst to a parent or guardian, it’s mind-boggling.”

Dr. Paul McHugh, former head of Johns Hopkins Psychiatry Department, condemned Oregon’s new policy as deeply troubling, saying “We have a very radical and even mutilating treatment being offered to children without any evidence that the long-term outcome of this would be good.”

McHugh also emphasized that these troubled teens need help, and not doing so would hurt them even more.  

“We can help them if we begin to explore with them and their families what they’re fearing about development,” he said, “what they’re fearing about being a young boy, a young adolescent appropriate to themselves.”

Transgender activists have lined up to praise the new law, saying it will help prevent future teen suicides, an argument the state of Oregon concurs.

“Parents may not be supportive,” said Jenn Burleton, leader of the Portland non-profit group TransActive who also underwent a sex-change operation. “They may not be in an environment where they feel the parent will affirm their identity, this may have been going on for years.”

http://www.truthrevolt.org/news/oregon-15-yr-olds-can-get-sex-change-without-parental-consent

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Court says state health-care plans can’t exclude gender-affirming surgery

A federal appellate court in Richmond became the first in the country to rule that state health-care plans must pay for gender-affirming surgeries, a major win for transgender rights amid a nationwide wave of anti-trans activism and legislation.

The decision came from a set of cases out of North Carolina and West Virginia, where state officials argued that their policies were based on cost concerns rather than bias. The U.S. Court of Appeals for the 4th Circuit rejected that argument, saying the plans were discriminating against trans people in need of treatment.

Judge Roger L. Gregory, an appointee of President Bill Clinton, wrote for the majority that the restrictions were “obviously discriminatory” based on both sex and gender.

“In this case, discriminating on the basis of diagnosis is discriminating on the basis of gender identity and sex,” Gregory wrote, because “gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it.”

The majority ruled that West Virginia’s policy also violated the Affordable Care Act’s anti-discrimination provision, a finding that has broad implications for other states’ Medicaid programs.

It’s the second ruling in favor of trans rights this month from the 4th Circuit, a once-conservative court that has become a trailblazer in the realm of transgender rights. The court was the first to say trans students had a right to use the bathrooms that align with their gender identity and the first to recognize gender dysphoria as a protected disability. Earlier this month, the court said a federally funded middle school could not ban a trans 13-year-old from playing on the girls’ track and field team.

The decision will be appealed to the Supreme Court, which recently allowed Idaho to enforce a ban on gender-affirming care for minors. West Virginia Attorney General Patrick Morrisey, who is running for governor, said in a statement Monday that he would “take this up to the Supreme Court and win.”

But the conservative-led Supreme Court has been reluctant to engage on these issues, letting multiple 4th Circuit rulings in favor of transgender rights stand. The court also generally waits until there is disagreement between circuit courts before getting involved.

All of these rulings split the 4th Circuit court down ideological lines, with judges appointed by Democrats joining the majority opinion and those appointed by Republicans dissenting. In the lead dissent from the ruling Monday, Judge Jay Richardson, a Trump appointee, wrote that there was no role for the federal court in policing what treatments health-care plans decide to cover.

The majority opinion, Richardson wrote, “treats these cases as new fronts upon which this conflict must be waged. But not every battle is part of a larger war. In the majority’s haste to champion plaintiffs’ cause, today’s result oversteps the bounds of the law.”

Richardson said what mattered is that trans patients have the same coverage of the same conditions as others. For example, he said, a trans patient with uterine cancer could get a hysterectomy under these plans.

“The different coverage accorded to treatments for different diagnoses is … based on medical judgment of biological reality,” he wrote. “States can reasonably decide that certain gender-dysphoria services are not cost-justified, in part because they question the services’ medical efficacy and necessity.”

Other states have banned hormonal treatment and surgery for trans minors; some have restricted care for transgender adults as well. Multiple other states have similar laws against insurance coverage for transition-related treatment. The Biden administration has moved to protect trans Americans through federal regulations, including guidelines released Monday that treat misuse of pronouns or refusal to let transgender employees use their preferred bathroom as workplace harassment.

In West Virginia, transgender Medicaid users challenged the state’s program, which since 2004 has by law banned “transsexual surgeries.” In North Carolina, state employees challenged their coverage, which in 2018 excluded surgical treatment of gender dysphoria — the clinical diagnosis of a disconnect between a person’s gender and birth sex.

Both states insisted that there was no bias in their coverage limitations, only cost concerns. Trans patients, they argued, were entitled to the same health treatments as everyone else but not specialized care.

“There is no service that is covered for a cisgendered person that is not covered for a transgender person meeting the same criteria,” Caleb David, an attorney for West Virginia, told judges on the appellate court during the oral argument. David added that the state had decided to provide psychiatric and hormonal treatment for gender dysphoria — just not surgery.

Advocates for trans patients said there was no medical justification for drawing the line there, when the state would cover such procedures for other conditions. They also said the financial explanation was suspect because so few people get gender-affirming surgery. It’s “a drop in the bucket,” Lambda Legal attorney Tara Borelli said during oral arguments. But even if the cost was significant, she argued, the cost of public health insurance “has to be a shared burden. It can’t be shunted onto the backs of a vulnerable minority group.”

The court agreed, saying cost-cutting could not justify covering the same treatments for health concerns other than gender dysphoria. For example, Gregory noted that under these plans, “cisgender people do receive coverage for certain gender-affirming surgeries,” including breast reconstruction for cancer patients after a mastectomy.

North Carolina began covering gender-affirming care in 2017 and stopped the following year, when Republican Dale Folwell became state treasurer. Julia McKeown, a professor at North Carolina State University, accepted her job in 2016, a few years into fully transitioning after a lifetime of “being adamant about what my gender was” but being limited in expressing it. She spent months preparing for surgery, only to be forced to cover the full cost along with all other treatment.

“It’s like having the rug pulled out from under you,” she said. “In some ways it’s worse than going in and knowing it was going to be denied.” She cut into her retirement savings rather than delay the surgery, calling herself “fortunate” to be able to do so.

McKeown grew up in a rural town in Florida and spent years pretending to be a man for fear of social and professional exclusion. Joining the lawsuit meant exposing herself to hate mail from strangers.

“In an ideal world, I would have loved to just move on with my life” after the surgery, she said. “At the same time, I feel a moral obligation to help those who can’t speak up for themselves, and for those who risk being fired or who have dependents on the state health-care plan who need access to treatment.”

Twenty-one Republican-led states asked the court to rule against the plaintiffs, focusing on disagreement over what physical interventions should be available to trans youth. But most major medical plans and the federal government cover gender transition treatment, which has been endorsed by mainstream medical associations. Studies indicate very few people who transition regret doing so or seek to reverse the changes, including those who start treatment in their teens.

Seventeen Democratic-led states and the District of Columbia urged the court to rule for the coverage, saying their “experience demonstrates that protecting access to gender-affirming care improves health outcomes for our transgender residents at little cost.”

An earlier version of this story reported that the contested insurance plans covered mastectomies for cancer patients but not for trans women. The plans covered mastectomies for all cancer patients, but did not cover the procedure for trans men who wanted their breasts removed to treat gender dysphoria.

LGBTQ+ rights in Iraq: how morality laws ramped up

Same-sex relationships and gender reassignment surgery are now criminalised in latest attack on targeted community

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Human rights groups have condemned a bill passed by Iraq's parliament that criminalises  s ame-sex relationships, with jail terms of between 10 and 15 years.

According to a copy of the legislation seen by Reuters , the law aims to "protect Iraqi society from moral depravity and the calls for homosexuality that have overtaken the world".

Amnesty International's Iraq researcher Razaw Salihy said that Iraq had "effectively codified in law the discrimination and violence" that members of the LGBTQ+ community have "been subjected to with absolute impunity for years".

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What is in the new law?

As well as a penalty of between 10 and 15 years in prison for same-sex relations, the Law on Combating Prostitution and Homosexuality mandates at least seven years in jail for anybody who promotes homosexuality or prostitution, and between one and three years for anyone who changes their "biological gender" or wilfully dresses in an effeminate manner. 

Doctors who perform gender reassignment surgery, men who "intentionally" act like women and those who engage in "wife swapping" will also face prison terms under the new legislation, said the BBC .

Why has it been introduced now?

Iraq had been among the few Islamic nations that did not explicitly criminalise same-sex relations , but "loosely defined" morality clauses in its penal code have been used to "target" LGBTQ+ people, said The Independent .

The new legislation was backed by conservative Shia Muslim parties that form the largest coalition in Iraq's mainly Muslim parliament. It is "a significant step in combating sexual deviancy given the infiltration of unique cases contradicting Islamic and societal values", Amir al-Maamouri, an independent MP, told Shafaq News.

It is indeed "sweeping", said Pink News , although "less extreme than originally planned", after a clause in an earlier version of the bill that called for the death penalty for same-sex acts was removed due to opposition from the US and Europe.

What has the reaction been?

The amended legislation has sparked condemnation from human rights groups and the international community.

It is "dangerous and worrying", said UK Foreign Secretary David Cameron. A statement from the US State Department said the law "threatens those most at risk in Iraqi society" and "can be used to hamper free speech and expression and inhibit the operations of NGOs across Iraq". The law would also weaken Iraq's ability to diversify its economy and attract foreign investment, the department said.

Data collected in 2022, reported by Pink News , suggested that just 2% of Iraq's population support homosexuality, while 55% oppose it. Ordinary Iraqis interviewed on Sunday expressed "mixed views" on the new law, said The Associated Press . 

What was the law before?

"Public perception and morality clauses in its penal code" mean that LGBTQ+ people have been "routinely targeted domestically and institutionally", said Pink News.

A 2022 report by Human Rights Watch said armed groups in Iraq were abducting, raping, torturing and killing lesbian, gay, bisexual and transgender people, and accused the Iraqi government of failing to hold perpetrators accountable.

The words "homosexual" and "gender" were banned in the media and on social media platforms in 2023. Officials claimed the move would safeguard societal values and maintain public order.

Over the past year, major Iraqi parties have "stepped up" criticism of LGBTQ+ rights, said Al Jazeera , "with rainbow flags frequently being burned in protests by both governing and opposition conservative Shia Muslim factions".

Renewed outbreaks of violence against Iraq's LGBTQ+ community have seen several people killed, including 28-year-old trans blogger Simsim, who was stabbed to death by unknown assailants in the city of Diwaniyah in February.

The new law "rubber-stamps" the country's "appalling record of rights violations", said Rasha Younes, deputy director of the LGBTQ+ rights programme at Human Rights Watch, marking "a serious blow to fundamental human rights".

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