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Nevada To Offer Health Benefits For Transgender Procedures

Esther Ciammachilli

Starting July 1, Nevada will offer health insurance for transgender-related medical care, including hormone therapy, gender reassignment surgery and mental health counseling. All are deemed medically necessary by the American Medical Association. Until now, these procedures haven’t been covered for public employees, like Jamie, a former state trooper.

From the time she was four years old, Jamie knew she was transgender.

“I used to ask my mom to dress me as a girl, or sit on the toilet and watch her put on makeup in the mornings," Jamie thinks back to her childhood. "And I remember on a few occasions asking her when I would be able to wear makeup, and got the standard response, boys don’t wear makeup.”

Jamie – who’s asked that we only use her first name – is now in her forties, or as she puts it closer to fifty than she’d like to be. She has a remarkable sense of humor, and don’t be fooled by her soft spoken nature. Jamie is a firecracker when it comes to karaoke, what she refers to as therapy.

Credit Esther Ciammachilli
Jamie singing karaoke in her living room. She says it's part of her therapy.

Jamie says she’s happiest with a microphone in her hand and her dog, Olive, at her side.

She’s retired now, but for 22 years, Jamie served with the Nevada Highway Patrol. In 1999, after several years of counseling, she began hormone therapy and her transition from male to female. Some might argue that being transgender then was even more taboo than it is now, especially in law enforcement.

“I started hormones, but I kind of withdrew back in and didn’t let it be known and I wasn’t dressing, I wasn’t anything, I just became the trooper I’m supposed to be,” Jamie says.  

Eventually, Jamie developed noticeable breasts, which she could no longer hide. In 2011, she ‘came out’ as transgender to her boss. A year later, she changed her name, got cosmetic surgery and began living as a woman full time. But her insurance – through the Public Employees’ Benefit Program, or PEBP – didn’t cover transgender procedures, which for Jamie has cost well over 100 thousand dollars.

“The majority of everything that I’ve had to do has been out of pocket," Jamie says.

Transitioning has been an ongoing process for Jamie. That’s why, last July, she asked PEBP to expand coverage for her. The board denied her request, but four months later, made a big change. Here’s board member Jeff Garofalo.

“I think as a plan and a state, it behooves us to recognize the evolving science and research and to understand and embrace the medical necessity of these procedures,” Garofalo said at a PEBP meeting in November. 

Last fall, PEBP decided to remove the section of its plan that excludes transgender therapy and procedures. Donna Lopez is PEBP’s quality control manager. She says cost was a major concern among members, but analysis shows such a low financial impact that…

“…it’s not even worth mentioning basically because the incidents of individuals are really pretty low. And so, for individuals who may be concerned oh, it’s just adding to the cost. No,” Lopez says.

Lopez says the plan doesn’t cover anything that took place prior to July 1.

And there are a handful of treatments that won’t be covered going forward, by PEBP or any other insurance company for that matter. Those include cosmetic surgery and…

“Voice modification and language modification,” says Rachael Walden.

That’s Rachael Walden, director of the Trans Voice Clinic at UNR, which offers voice and speech therapy to transgender people. Sessions are once a week for about twelve weeks and cost 25 dollars each time and Walden says the clinic has a hard time getting insurance to cover this.

“It’s not a functional voice disorder, it’s not damage as result of an illness or injury, so insurance companies typically will not cover any of that," Walden says.

Credit Esther Ciammachilli
Graduates students and clients at the Trans Voice Clinic at UNR gather for a special lecture on the difference between men and women's gait, or how they walk. As well as voice and language therapy, it's one of the many classes offered to transgender clients.

Still, Walden says, transgender people often find voice therapy helps with their transition.   

“There are techniques that will enhance a person’s voice and can actually change the pitch to a higher frequency,” Walden explains. 

The majority of their clients are male to female transgender. That’s because, Walden says, they take estrogen during hormone therapy and unlike testosterone, estrogen doesn’t change a person’s voice, so these individuals need additional vocal therapy in order to sound more feminine. And when that happens, Walden says, transgender people begin to feel more like the person they want to be.

“The voice is the essence of who you are. If you present with a voice that is more female, you’re going to pass more as female,” Walden says.

“Someone who is transgender has to look at everything, every aspect of their being, they have to look at and question and sort through,” Jamie continues. 

That’s Jamie again. She’s hoping to get into voice therapy soon and she says she still needs more surgery. But because she’s on a fixed income, she can’t afford it at this time. And even though her transition wasn’t covered, she applauds the PEBP board for changing their plan and hopes this decision will relieve at least some of the stress future transgender state employees will have to face. 

Esther Ciammachilli is a former part-time broadcaster at KUNR Public Radio.
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