18 Wyoming Legislators Upset Transgender Surgeries Included Under Medicaid, But They Aren't

A group of Wyoming legislators wanted to know why transgender surgeries are no longer on the Medicaid-excluded list, but the Wyoming Department of Health says they have never been covered.

Leo Wolfson

June 06, 20234 min read

State Rep. John Bear, R-Gillette, leads the Wyoming Freedom Caucus, which sent a letter asking the state why gender surgeries aren't on the Wyoming Medicaid excluded list.
State Rep. John Bear, R-Gillette, leads the Wyoming Freedom Caucus, which sent a letter asking the state why gender surgeries aren't on the Wyoming Medicaid excluded list. (Matt Idler for Cowboy State Daily)

Eighteen members of the state Legislature and Wyoming Freedom Caucus have sent a letter to the head of the Wyoming Department of Health asking why transgender-related treatments are no longer excluded from the department’s updated Medicaid handbook. 

The department says the lawmakers got some bad information, because the treatments still aren’t covered.

Kim Deti, spokesperson for the department, told Cowboy State Daily on Monday afternoon that Wyoming Medicaid has not paid for any gender reassignment surgeries since at least 1993 and has no plans to provide coverage for this procedure.

“In fact, the program’s administrative rules prohibit coverage of this procedure,” Deti said.

Cosmetic Or Medically Necessary? 

Stefan Johanssen, director of the Wyoming Department of Health, responded to the Freedom Caucus letter Friday, confirming that gender-reassignment surgery is considered cosmetic care by Wyoming Medicaid, which is not covered.

Johanssen said Wyoming Medicaid will only pay for services it deems to be medically necessary.

In a January press release, health advocacy group Healthy Wyoming said it views "gender-affirming care" as a medical necessity, a viewpoint shared by the American Medical Association and the American Psychiatric Association.

Although it would seem this would create an opening for those who argue that such treatments are medically necessary, Johanssen said those would still be denied under this claim.

Freedom Caucus letter 6 5 23

Back Story

What drew the Freedom Caucus’ alarm was removing transgender-related services from the DOH exclusion list.

“Did you know the WY Department of Health quietly removed transgender surgeries from the list of treatments not covered by WY Medicaid?” the caucus quizzed its followers before Johanssen responded. 

In 2016, the Medicaid handbook specifically listed “transsexual surgery” as one of the services not covered by Wyoming Medicaid. By 2022, the procedure had vanished from the exempted list in the updated handbook.

Deti said on Monday in 2019 a decision was made to remove the procedure from the exclusion list as the department worked to ensure administrative rules were updated to ensure clarity on the issue. 

But in a 2019 Washington Post story, Deti took a slightly different stance, showing the department gave at least some consideration to a different policy.

“Wyoming Medicaid has recently removed transgender surgery from the list of excluded services,” Deti told the Post. “However, we have never been asked to cover transgender surgery. Should we receive a request for coverage in the future, we would review the case for medical necessity and compliance with industry standards and best practices.”

Even the Trans Health Project took notice in 2021, saying, “Wyoming Medicaid has no explicit policy regarding transgender-related health care.”

The administrative rules were finalized later in 2021, and Johanssen said gender reassignment surgery is specifically not allowed in Wyoming’s Medicaid Rules.

Deti said Monday there were no requests to cover the procedure prior to 2019 or since. 

“So, to summarize, zero requests for these surgeries and zero public dollars spent by Wyoming Medicaid for these surgeries,” she said.

The Caucus And Transgender

Members of the Freedom Caucus have generally opposed transgender-friendly legislative maneuvers in Wyoming.

During the 2023 legislative session, members of the caucus supported bills prohibiting doctors from performing transgender operations on minors and transgender girls from participating in girls’ sports, the latter of which passed into law.

Opponents of both bills expressed concerns about the mental health of those seeking or have already received transgender-related treatments.

“No long-term, evidence-based studies exist to support the notion that these harmful procedures and treatments are medically necessary,” the Freedom Caucus writes. 

During discussion on a Medicaid expansion bill, Rep. John Bear, R-Gillette, chairman of the Freedom Caucus, added an amendment to the bill prohibiting any state money from being used for transgender surgeries. 

In its letter to Johanssen, the caucus cited a 2011 Swedish study that found those who received transgender surgeries had a higher risk of suicide in the long term.

A more recent 2022 study from the Society for Research in Child Development also found that transgender youth are two to three times more likely to report suicidal thoughts, depression and anxiety than their peers, with studies showing that 30%-50% of transgender youth reporting attempting suicide. 

The same study also found that transgender youth with supportive families and who have socially transitioned show normal rates of depression and only slightly more anxiety than their peers.

Leo Wolfson can be reached at leo@cowboystatedaily.com.

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Leo Wolfson

Politics and Government Reporter