Fenway Health Statement on United States v. Skrmetti
December 6, 2024
The Trans Health Program at Fenway Health supports members of trans and gender diverse communities, their families, and the providers who serve them. We provide patient-centered, evidence-based care to ensure trans and gender diverse people are informed and affirmed in their gender and healthcare needs.
The Trans Health Program Newsletter is a tool for proactive communication with patients and community members about all things trans and gender diverse health. We are particularly attuned to the needs of people given the political climate and intend to use this tool to communicate proactively about government policies, medical care updates, and important resources. In this issue are commonly asked questions since the election, a message from our CEO, and resources for care and support.
We extend warm wishes, comfort, rest, and joy to each of you during this uncertain time. We know that accessing care and community can be difficult for many. We’re here for you. Please reach out if you need help. Rest assured, leadership at Fenway is planning and coordinating with community, state, and federal officials to protect access to care. We’re in this together.
Many of you have had questions about what the current political environment might mean for gender-affirming care and services at Fenway Health. We will be answering these questions to the best of our ability on this FAQ page.
Fenway is deeply committed to our mission and continuing our work providing services for all LGBTQIA+ individuals. We have no intention of discontinuing gender-affirming care or other services. Fenway is working at community, state, and federal levels to anticipate any attacks on gender affirming care – or other medically necessary care – in order to prevent any disruption in services. Our goal is for you to continue to get the care you need and deserve in a manner that is unchanged from how you experience it now.
Our leadership is working diligently with our local, state, and federal politicians and partner organizations across the country to anticipate any attacks on gender affirming care – or other medically necessary care –to prevent any disruption in services. Currently there are a lot of unknowns about potential federal policy changes, but here at Fenway Health we are doing our best to anticipate possible attempts at restricting access to care. Fenway is dedicated to keeping our communities updated on our response to any proposed policy changes as well as how and where we are advocating.
Currently policies restricting or banning gender affirming care for minors are being determined on a state-by-state basis. There is no indication that gender-affirming care is under threat here in Massachusetts at this point in time. It is unclear if the Federal government will seek involvement in these policies or attempt to insert their governance in other ways like putting restrictions on Medicare or Medicaid coverage, limiting funding for federally qualified health centers, requiring extra administrative burden to provide GAC, or something else.
On December 4, the first case concerning a ban on gender affirming care in Tennessee was heard at the Supreme Court. The United States is challenging Tennessee’s law stating it violates the Equal Protection Clause of the 14 Amendment in The United States vs Skrmetti. This case is historic, and its decision will be groundbreaking, setting a precedent that bans on gender affirming care for minors – or gender affirming care in general – is either unconstitutional based on the premise of sex discrimination, or that these state bans are legal, making way for more government involvement in medical care and science. Read Fenway’s statement on the case here.
I’m worried about who has access to information in my medical records – how is this data kept secure?
Medical records are protected under HIPAA to limit government overreach. Local and federal governments are able to serve court orders for medical records in the case of criminal investigations or if a patient is believed to be a foreign agent. All government requests for medical records are reviewed by Fenway’s legal team and we have been reassured that if any requests appear to be nefarious, they will be reviewed with outside counsel and possibly the Mass Attorney General’s Office. Additionally, the Massachusetts government is highly protective of gender affirming care, and they will continue to be.
Learn more about HIPPA here.
Should I remove gender dysphoria from my diagnosis or problems list in my medical records?
We understand the desire to remove gender dysphoria from your chart, but removing a diagnosis code may not be as helpful or straightforward as it seems.
Massachusetts-based insurance plans cover gender-affirming care. However, in order for the insurance company to recognize the request or service as medically necessary for gender-affirming purposes, we typically need to use the diagnosis code F64.9, or gender dysphoria. This specific coding for insurance coverage often applies to things like surgery or expensive medications. Given the new administration and possible policy changes, Fenway is working with policy makers and MA insurances to recognize alternative codes to reduce any potential risk to patients.
We can sometimes use another, more vague diagnosis code if it is on your list (for example, Hormone Disorder), but we cannot guarantee there will not be any issues with insurance coverage. It is not legal for us to use codes that may be considered clinically inaccurate under the Federal False Claims Act.
Removing a diagnosis code such a gender dysphoria also would not remove other information specific to your trans or gender diverse identity from the chart, such as the content of notes, MyChart messages, medications, and medical/surgical histories.
Alternatively, or additionally, you can choose to restrict access of your medical record to other linked institutions via Care Everywhere. If you do choose this, remember that other health centers where you may see specialists or seek emergency services will not have access to your medications or problem lists, which may restrict or slow down access to these other services.
What is the Massachusetts Shield Law?
Massachusetts is one of 17 states in the US that has a Shield Law as protection related to the provision of gender-affirming health care. The Shield Law protects providers who are physically located in Massachusetts from the consequences of civil and criminal actions in other states that restrict or criminalize gender-affirming or reproductive health care. This law in MA extends protections for care provided by a MA provider regardless of the patient’s location at the time the care is provided. However, the Shield Laws will not protect providers who are providing care when physically out of the state of MA.
Shield Laws have yet to be tested in the US. Fenway is working with our local policy makers to ensure that our state’s laws are strong, ready to be tested, and have the broad protections that we, as providers, need to feel safe and protected providing this medically necessary care.
Learn more at Know Your Rights: Shield Law
857.313.6589 or [email protected]
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