Maryland legislature passes Trans Health Equity Act

Transgender Marylanders will soon be able to receive additional gender-affirming procedures under the state’s Medicaid program, following lawmakers’ passage of a key piece of legislation this week.

The Maryland General Assembly on Thursday evening voted to send the Trans Health Equity Act (THEA) to Gov. Wes Moore’s desk, where he is expected to sign it into law.

The House of Delegates voted 93-39 to advance the measure. Moore has pledged to sign it, saying, “We should not be asking any Marylander to validate their humanity. We should not be asking any Marylander to try to justify their humanness.”

The bill expands procedures related to gender-affirming care that are covered by Maryland’s Medicaid program. Currently, covered procedures are limited to a small number of services like mental health treatment for gender dysphoria, continuous hormone replacement therapy, and gender affirmation surgery.

Under THEA, procedures like hair alteration, voice modification surgery, fertility preservation, and alterations to other parts of the body like the abdomen, face, neck, and trunk, would be covered by Medicaid. THEA would also cover revisions and reversals of prior treatments.

The bill would take effect on Jan. 1, 2024.

Similar legislation passed the Senate chamber in 2022, and made it out of House committee. But it failed to pass that year after never coming up for a vote on the House floor.

This session, opponents tried to focus on defining specifically which procedures and surgeries would be prohibited for people under the age of 18, but the new measure doesn’t change current Maryland law regarding minors. Parental consent is already required for health care decisions for transgender youth, and that doesn’t change with the passage of THEA.

Del. Bonnie Cullison, a Montgomery County Democrat, knocked down arguments made against the legislation.

“No child is making this decision independently,” Cullison said.

It’s rare for a person under 18 to get a gender-affirming surgical procedure. Though if a parent, the patient, and their medical providers deemed it necessary because they’d “be in danger without that kind of treatment,” it could be allowed, Cullison said.

“We would say under no circumstances can we allow an individual who is at risk of self-harm, serious risk for self-harm, to not get the treatment they need,” she said.

Maryland lawmakers passed THEA just a day before International Transgender Day of Visibility on March 31. Moore is the first Maryland governor to commemorate the day in the state.

THEA’s passage also comes at a time when lawmakers in other states have sought to pass laws restricting health care, education, and other rights for trans people.

According to Trans Legislation Tracker, in just the first three months of 2023, 26 anti-trans bills have passed in state legislatures around the country, out of nearly 500 that have been introduced; 43 bills have failed, and 424 are still active. The site tracks legislation that “seeks to block trans people from receiving basic healthcare, education, legal recognition, and the right to publicly exist.”

Even in Maryland, where Democrats outnumber Republicans 2-1, a bill was introduced this year in the House of Delegates that sought to limit participation on sports teams based on players’ gender assigned at birth.

The bill would require “certain interscholastic and intramural junior varsity and varsity athletic teams or sports sponsored by certain schools to be expressly designated based on biological sex; prohibiting certain entities from taking certain adverse actions against a school or county board of education for maintaining separate interscholastic and intramural junior varsity and varsity athletic teams and sports for students of the female sex; and providing that certain individuals have the right to bring a civil action under certain circumstances.”

Sponsored entirely by Republicans, the bill is still technically active, though it is considered dead after the House Ways and Means Committee gave it an unfavorable report.

One of the members of the committee, Del. Kris Fair of Frederick County, was vehemently opposed to the bill.

“Bills like this not only materially do harm. That is, if they were implemented, they would great harm to large portions of our community, and I’ll say not just trans people, but all people,” he said. “The impact of just simply bringing forth legislation like this that forces trans people to come down a hearing to basically justify their own existence to a bunch of politicians is heartbreaking to have to watch.”

In the national rush to ban books, stories about “transgender individuals and characters are commonly challenged and banned, making up about 9% of banned books,” according to PEN America.