Medicare Shines Light on Gender Minority Health Disparities

by Cameron McConkey

National profiles of trans and gender nonconforming (T/GNC) people are scarce, but new data highlights mental and physical health disparities in T/GNC who are elderly and/or disabled.

Lack of visibility of trans and gender nonconforming (T/GNC) people in the healthcare literature and databases is a serious public health problem. From the policy to research to service delivery sectors, numerous barriers remain in the way of health equity for T/GNC individuals (e.g., National Census 2020 representation, discriminatory policies from Health and Human Services). Unsurprisingly, these barriers are only compounded by able- and ageism in the face of elder and/or disabled T/GNC people.

New research in the journal Health Affairs used data from the Center for Medicare and Medicaid Services (CMS) to explore health disparities in T/GNC Medicare recipients. The study looked at complete national Medicare data from 2009–14. For context, the last year of the study (2014) included data from over 3,000 disabled T/GNC people (0.86% of total disabled cohort) and 600 elderly T/GNC people (0.06% of total elderly cohort), respectively. Overall, the study showed that many more T/GNC individuals:

• interface with the physical and mental health systems,
• report mental health issues and service utilization, and
• visit emergency departments

…than age- and comorbidity-matched cisgender Medicare recipients.

Since the close of the study, recent strategies have aimed to, at least, better capture and affirm gender diversity in health systems. In 2016, CMS instituted a policy where any certified electronic health software (EHS) platform would have to include fields for sexual orientation and gender identity (SO/GI). Adoption of the two-step approach to SO/GI by the Center of Excellence for Transgender Health has also advanced this effort.

Federal pro-diversity SO/GI policies, however, are under intense scrutiny given the current administration landscape. Broad studies of T/GNC people like the one reported here are needed to relay information about the health needs of elderly and disabled T/GNC communities, which face incredible inequity and disparity.

You can read the full text of the study in Health Affairs here: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1295