- Pooja Gehi
staff attorney and the director of the Immigrant Justice Project at the Sylvia Rivera Law Project.
- Angie Milan-Cruz
a lead plaintiff in the class-action lawsuit filed by the Sylvia Rivera Law Project against the New York State Department of Health for Medicaid’s exclusion of transgender healthcare coverage.
In New York, and in most other states, a transgender person with Medicaid cannot obtain coverage for hormone therapy, which non-transgender women routinely obtain in the form of birth control. The Sylvia Rivera Law Project and other groups have filed a lawsuit challenging a 1998 regulation which prevents Medicaid recipients in New York from accessing sex reassignment surgery, hormones and other forms of care. The lawsuit follows a number of recent victories for transgender healthcare. Last month, the U.S. Department of Health and Human Services overturned Medicare’s blanket ban on sex reassignment surgery, meaning recipients of Medicare will no longer have their claims for coverage of surgery automatically denied. Just last week, Massachusetts became the third state in the country to cover transgender healthcare under Medicaid. All this comes as activists prepare to mark the 45th anniversary of the Stonewall uprising in New York City on June 28, 1969, a seminal event that helped launch the modern LGBT movement. We speak with Pooja Gehi, staff attorney at the Sylvia Rivera Law Project, which filed the class-action lawsuit over Medicaid coverage in New York, and Angie Milan-Cruz, a plaintiff in the lawsuit.
NERMEEN SHAIKH: Here in New York and in most other states, a transgender person with Medicaid cannot obtain coverage for hormone therapy, which non-transgender women routinely obtain in the form of birth control. That’s a discrepancy activists are trying to change with a new lawsuit. Filed late last week by the Silvia Rivera Law Project and other groups, the lawsuit challenges a 1998 regulation which prevents transgender people from accessing sex reassignment surgery, hormones and other forms of care. In this video produced by the Silvia Rivera Law Project and GLAAD, healthcare providers and transgender people talk about the importance of basic health coverage.
STEPHEN: But I’ve always known that I wanted to move here, for the city’s vibrant artistic community. As a trans person, I would hope that I’d be welcomed, but many trans people aren’t, because we don’t have the basic healthcare coverage that we need to survive.
EGYPTT: In New York and many other states, transgender people like myself are so often refused coverage, even for routine and preventive care.
REINA GOSSETT: Every day, people come into the Silvia Rivera Law Project because they have been denied the basic healthcare they need to survive.
FINN: Transgender people, like all people, are healthier when they get the medical care they need.
RONICA: Trans medicine is a medically necessary intervention. Many people believe that doing—providing hormones for trans patients is cosmetic, but as a medical provider, I can tell you how crucial it is for the health and lives of trans people to have knowledgeable, trans-friendly providers.
NERMEEN SHAIKH: The lawsuit over Medicaid coverage in New York follows a number of recent victories for transgender healthcare. Late last month, the federal Department of Health and Human Services overturned Medicare’s blanket ban on sex reassignment surgery. The change means recipients of Medicare will no longer have their claims for coverage of surgery automatically denied. Just last week, Massachusetts became the third state in the country to cover transgender healthcare under Medicaid.
AMY GOODMAN: All of this comes as activists are preparing to mark the 45th anniversary of the Stonewall uprising in New York City, a seminal event that helped launch the modern LGBT justice movement.
To talk about all these developments, we’re joined by Pooja Gehi, staff attorney and director of the Immigrant Justice Project at Sylvia Rivera Law Project, which has just filed the class-action lawsuit over New York Medicaid’s exclusion of transgender health coverage. And we’re joined by Angie Milan-Cruz, one of the two lead plaintiffs in the suit.
We welcome you both to Democracy Now! Angie, your name is the lead name. The other person didn’t want to be identified. Talk about why this is so important to you.
ANGIE MILAN-CRUZ: My personal experience has been hardship, depression, not being just accepted for who I am. I have to look at myself every day in the mirror and see the perfect me, but I want the whole package, where I can feel comfortable under my own skin.
AMY GOODMAN: And what would that whole package be? Why sue the New York State Department of Health?
ANGIE MILAN-CRUZ: To have the right to have reassignment surgery.
NERMEEN SHAIKH: So, Pooja Gehi, could you explain why it is that Medicaid did not do what Medicare did in allowing these procedures?
POOJA GEHI: Yeah, well, the Medicaid regulation in the state of New York is really dated. It goes back to 1998. And it was passed sort of under the radar, and it’s a blanket exclusion to all transition-related healthcare. The only comments submitted were by two physicians, who actually said that the care is medically necessary and not experimental. And the state of New York went ahead anyways. And we think now is the time, right, with this Medicare decision. There’s also the Affordable Care Act, has a regulation that says it cannot discriminate on the basis of gender identity and expression, which we think means all state-based Medicaid programs should also cover transition-related healthcare.
NERMEEN SHAIKH: And they make the argument that somehow—Medicaid makes the argument that these procedures are somehow dangerous for people who undergo them. And is that the justification that they provide?
POOJA GEHI: Mm-hmm.
NERMEEN SHAIKH: And if that’s the case, then how come that wasn’t true when Medicare changed its policies?
POOJA GEHI: Mm-hmm. I mean, I think that that is the justification that the Department of Health in New York uses, and it’s extremely dated. We’ve seen—and actually, the regulation is supposed to be up for review each year. And we haven’t had any—seen any movement on it since 1998. During that time, the American Medical Association has said that the care is medically necessary—the American Psychiatric Association, the World Professional Standards for Transgender Healthcare, now Medicare and the Affordable Care Act. So we think now is the time that New York really needs to get on board.
AMY GOODMAN: Last month in New York, activists interrupted a speech by the New York state health commissioner to demand Medicaid coverage for transgender healthcare. Members of the Sylvia Rivera Law Project took over the stage at a health conference during a keynote address by Commissioner Howard Zucker. They displayed a banner with the hashtag "#TranshealthcareNOW." Member Reina Gossett spoke from the stage for several minutes.
REINA GOSSETT: We’re here to say that right now New York State Department of Health has a regulation that specifically excludes transgender people from accessing healthcare through Medicaid. Commissioner Howard Zucker has the power to change that. Please join us in demanding that Commissioner Zucker and the Department of Health end discrimination against transgender people in the great state of New York.
AMY GOODMAN: This is your organization, the Sylvia Rivera Law Project.
POOJA GEHI: Yes.
AMY GOODMAN: Pooja Gehi, explain how New York differs from other states, like Massachusetts.
POOJA GEHI: Yeah. Well, New York continues to have a regulation that specifically excludes all transition-related healthcare. And in actuality, they cover the exact same healthcare for non-trans people, but not for trans people under Medicaid. So what happened in Massachusetts is that the state—the state Medicaid program reversed its regulation that excluded transition-related healthcare. And New York actually has the power to do the exact same thing.
NERMEEN SHAIKH: And this care has actually been referred to as life-saving care. Could you explain how and why?
POOJA GEHI: Yeah, so, the Sylvia Rivera Law Project was founded in 2002. And since then, it’s been one of the most intense, major, life-threatening things that we’ve seen, is the way in which people are not able to access healthcare. And, you know, like any kind of healthcare, when you’re not able to access what you need, you’re more likely to suffer from suicidality, have increased rates of depression, not be able to work, not be able to participate in society in the way that you want to. And we also see people not able to access healthcare getting caught up in cycles of poverty and incarceration, because they are forced to resort to the black market, or they’re forced to do—engage in survival economies to be able to access the healthcare that they need, which then, of course, makes them more likely and more vulnerable to policing and incarceration.
AMY GOODMAN: Over the weekend, a vigil was held for a transgender woman whose body was found burned and hidden behind a dumpster last Thursday in Fort Myers, Florida. The brutal murder of Yaz’min Shancez was not labeled as a hate crime by local police. News-Press recently spoke with Yaz’min’s aunt.
REPORTER: What kind of person was she? What do you remember most about her?
BEATRICE LOGGINS: Just being a happy person, just full of life, that did not deserve to go out like that. He really didn’t. Just happy. I mean, liked to dance all the time, the life of the party. "Hey, let’s get it started!" you know, that type of thing. And I can just hear the voice over and over, you know what I’m saying? And it’s—it’s just hard.
AMY GOODMAN: The National Coalition of Anti-Violence Programs recorded more than 2,000 hate incidents against LGBT people last year, including 18 anti-LGBT homicides. Eighty-nine percent of the murder victims were people of color; 72 percent were transgender women. Do you, Angie, feel threatened?
ANGIE MILAN-CRUZ: Yes, absolutely. You know, my experience—being incarcerated, not being accepted for who I am, not able to find a job because of my sexual identity—is heartwrenching for me, per se.
NERMEEN SHAIKH: And when did you first approach Medicaid for assistance with sex reassignment surgery?
ANGIE MILAN-CRUZ: Over 15 years.
NERMEEN SHAIKH: And what do you think, Pooja, are the prospects for success, given, as you’ve pointed out, that so many other state and federal bodies have changed their position on sex reassignment surgery and other assistance to trans people? What do you think the prospects are for success with this class-action lawsuit?
POOJA GEHI: Yeah, I feel really positive about it. I mean, our main—our major argument says that the federal government is saying that you cannot discriminate—states are not allowed to discriminate in the care that they provide on the basis of diagnosis, which is exactly what New York state is doing. So, because Angie is a trans woman, she’s not able to access the exact same care that non-trans people are able to access through Medicaid.
AMY GOODMAN: I want to go to a clip of Sylvia Rivera herself, which the Sylvia—she is the person who the Sylvia Rivera Law Project is named for, remembering the Stonewall uprising. She was one of the leaders of it, just down the street from our studios right here, in Greenwich Village. This is from the audio documentary Remembering Stonewall that was produced by Dave Isay in 1989 for the 20th anniversary of the uprising. Here’s Sylvia Rivera remembering what happened on that day 45 years ago.
SYLVIA RIVERA: Here, this queen is going completely bananas, you know, jumping on, hitting the windshield. The next thing you know, the taxicab was being turned over, the cars were being turned over, things—windows were shattering all over the place, fires were burning around the place. It was beautiful. It really was. It was really beautiful.
AMY GOODMAN: That was Sylvia Rivera. She died in 2002. The images of the people in the Stonewall bar with their stiletto heels hitting the police officers, launched the modern-day gay rights movement and LGBT movement. Why did your organization take her name?
POOJA GEHI: Yeah, well, Sylvia Rivera was a trendsetter, founder of Stonewall, but she also believed in intersectionality. So she was also a member of the Young Lords, where she provided meals for Puerto Rican folks in Harlem. She was part—was an anti-prison activist. She talked—she was an anti-racist activist. She was a trans activist. And she talked a lot about how all of those things are inextricably related, right? Which is what we really believe at the Sylvia Rivera Law Project, too. We know that for people to express their gender identity and expression, it’s so much more challenging when people are also people of color, immigrant communities, people in prison, people living in poverty, people struggling against other barriers.
AMY GOODMAN: Well, we want to thank you both for joining us, Pooja Gehi, staff attorney at the Sylvia Rivera Law Project, and Angie Milan-Cruz, the lead plaintiff in the class-action suit to get Medicaid to cover hormone therapy and other forms of care for transgender people.
This is Democracy Now! When we come back, it’s the 50th anniversary of the most massive bombing in history, the bombing of Laos. Stay with us.