BILL SUMMARY:
Your tax dollars will pay for medicine and surgery to sterilize and change the gender of children. This radical new law codifies “gender affirming treatment,” but does not include mental health treatment. Parental notification is not required by this bill. Cosmetic surgery and fertility preservation for trans surgeries was included in the bill, however amendments to provide similar coverage to cancer patients was rejected. This law will take effect Oct. 1, 2023.
BILL NUMBER: SB 460/HB283
SPONSORS of SB 460: Senators M. Washington, Augustine, Elfreth, Feldman, Guzzone, Hettleman, King, Kramer, Lam, Smith, Waldstreicher, Zucker, Ellis, and Hayes
HB 283: Delegates Kaiser, Cullison, Acevero, Allen, Amprey, Atterbeary, Bagnall, B. Barnes, Barve, Boyce, Cardin, Charkoudian, Clippinger, Ebersole, Edelson, Embry, Fair, Feldmark, Fennell, Foley, Forbes, Fraser–Hidalgo, Grossman, Guzzone, Hill, D. Jones, Kaufman, Kelly, Kerr, Lehman, R. Lewis, Lopez, Love, McCaskill, Mireku–North, Moon, Palakovich Carr, Pasteur, Qi, Queen, Reznik, Rosenberg, Ruth, Shetty, Simpson, Smith, Solomon, Stein, Stewart, Taveras, Terrasa, Valderrama, Vogel, Watson, Wells, Wilkins, Ziegler, Pena–Melnyk, White, and Martinez
LAST ACTION: Signed by Governor Moore on May 3, 2023 effective October 1, 2023.
SB 460 – Chapter 252 of Laws of 2023. HB 283 – Chapter 253 of Laws of 2023
BILL ANALYSIS:
Requires Maryland’s Medicaid Program to provide puberty blockers, cross-sex hormones and/or surgery to remove the reproductive organs and refashion an individual’s physical body to align with an individual’s desired gender identity. The bill prohibits the Medicaid Program from establishing a categorical exclusion, which could include minimum age, for a particular gender-affirming treatment. A child or teen could request, or be recommended for radical drug or hormone therapy or radical surgical removal of their internal and external reproductive organs. Only confirming counseling where the child’s self-diagnosis is confirmed is recommended. Counseling that neutrally explores why the young person desires to make this change or what underlying issues such as physical abuse, anxiety, or depression that, if addressed, might help the individual feel comfortable in their biological gender is considered conversion counseling. Parental notification or approval for minor children is not included.
Under SB 460 Medicaid would pay for services related to gender transition, including cosmetic services, that would not be paid for other reasons including for cancer patients. This includes alterations to the voice, abdomen, chest, trunk, face, neck genitals and gonads, and laser treatment for scars and standard fertility preservation procedures.
This law adopts a new standard of care reminiscent of the mid-20th century’s practice of psychosurgery to treat psychiatric disorders and depression, including lobotomy. The law fails to consider gender dysphoria as what it is, a mental health condition.
SB 460 will work in tandem with SB 41 of 2021 that lowered the age of consent that a minor can seek counseling, diagnosis, and treatment for mental or emotional disorders without parental consent, from 16 years old to 12 years old. HB 111/SB26 of 2023 requires the MD Dept. of Health of establish an Express Lane Eligibility Program by 1/1/25 to automatically enroll individuals in Maryland Medicaid or MD Children’s Health Program, if they are eligible for the Supplemental Nutrition Assistance Program. The age of consent for transition treatment is 16 years old, however, children can begin the social transition at any age. For example, in school kindergarten children may choose their gender if they have accepted the Policy 443 on Transgender and Non-Conforming Students.
It is widely recognized that the human brain is still developing until about age 25, which is why juveniles are not held to the same level of responsibility for serious crimes committed under age 18. For these same reasons, a child under age 18 should not be able to submit to actions that permanently remove their ability to reproduce and become a parent themselves.
Reference: Mariam Arain, Maliha Haque, et. al., National Library of Medicine, Neuro psychiatric Disease and Treatment, 2013; 9: 449-461 (available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621648/#b5-ndt-9-449); Quoting Gavin L, MacKay AP, Brown K, et al. Centers for Disease Control and Prevention (CDC) Sexual and reproductive health of persons aged 10–24 years – United States, 2002–2007. MMWR Surveill Summ. 2009;58(6):1–58.
COST ESTIMATE: Under this law Medicaid expenditure will increase by a significant amount starting fiscal year 2024, approximately $2.1 million; as Medicaid must provide coverage for medically necessary “gender affirming treatment.”
According to the bill’s Fiscal Note: In 2022, the Williams Institute reported that there were 24,000 transgender adults in Maryland. An estimated 6,000 of these adults are enrolled in Medicaid. Medicaid expenditures will increase by an indeterminate, but likely significant amount, beginning in fiscal 2024. If 125 individuals (reflecting utilization in calendar 2022 and assumed growth of 25 additional individuals) received all of the new services available under the bill, including fertility preservation, Medicaid expenditures would increase by $7.6 million (68% federal funds, 32% general funds). If 125 individuals received only some services, in this example, hair alterations and laryngoplasty/voice modification surgery (totaling $17,000 per person), Medicaid expenditures increase by $2.1 million.
Estimates of the cost for new services covered under the bill, range from less than $800 for voice therapy/voice lessons to more than $25,000 for facial feminization or masculinization surgeries. Medicaid expenditures increase by as much as $52,743 per person. However, this estimate does not include an average of $8,000 per person for cryopreservation of either ova, embryo, or sperm, as well as an ongoing annual cost to store the ova/embryo/sperm of $500 per year. Fertility preservation services are currently not covered for Medicaid participants for any reason even for those with cancer. Provision of fertility preservation services for all Medicaid participants could significantly increase costs (an estimated $8.1 million annually based on 0.07% of total enrollment utilizing the services).