Hair removal can be an integral component of gender affirmation for transgender and genital minority (GM) individuals, and these guidelines outline what clinical information MassHealth requires from providers in order to obtain prior authorization (PA) for hair removal services.
These guidelines apply to all MassHealth managed care plans, One Care organizations, Specialized Care organizations (SCO), and PACE programs.
General Information
As with other MassHealth services, coverage for PACE members is subject to the restrictions and policies of their plan (such as an Accountable Care Partnership Plan, Managed Care Organization (MCO), One Care organization (OCO), Senior Care Options or PACE). Providers serving members enrolled in such plans should refer to the relevant medical policies of these plans in order to receive information specific to that plan.
Analysis by the UM subcommittee showed that 42% of carriers have broad cosmetic exclusions for hair removal therapy without explicit consideration of medical reasons, 36% offer coverage for preparation of skin flaps and grafts for gender affirming surgery, while 11% cover facial hair reduction when other requirements have been fulfilled.
Treatment of Gender Dysphoria
Gender dysphoria refers to when someone feels trapped within a body that does not reflect their internal perception of themselves as male, female, or otherwise (it can happen at any age, though symptoms usually become more pronounced during puberty due to physical changes associated with gender transition), often manifesting through distressful symptoms such as physical changes that cause gender transition itself and associated gender transition-related changes such as hormone replacement therapy or surgery to alleviate them.
Hair removal is part of the transgender affirmation process and MassHealth covers it when all criteria for its medical necessity treatment are fulfilled:
Member meets DSM-5 criteria and has been diagnosed with gender dysphoria; diagnosis should be documented by a licensed mental health provider such as a physician or psychologist.
Fallon Health requires this assessment to include a thorough clinical examination conducted by a licensed physician or psychologist approved to provide these services, who is approved to do so. Fallon Health reserves the right to request copies of their credentials prior to conducting this evaluation.
Gender dysphoria must have persisted and been well documented over an extended period, at least six months prior to being assessed.
Treatment of gender dysphoria in children involves helping them understand their feelings and learn to cope with them in effective ways. Behavioral therapy may teach kids to use pronouns that match their gender, as well as using public bathrooms and facilities appropriate to them.
Hair removal can provide relief for gender dysphoria sufferers and help children engage in activities appropriate for their sexe.
Most health insurance plans provide policies that allow children to remove facial hair as part of gender affirmation therapy, and many policies cover hair removal of surgical sites for people undergoing gender dysphoria treatment. Most frequently electrolysis or lasers are employed; dermatologists may also offer this service.
Treatment of Tissue Donor Sites
Tissue donor sites require special care to avoid complications. Donor sites are subject to mechanical trauma and hypergranulation during harvesting, which could result in infection if improperly managed. An infection at a tissue donor site may hinder healing of split-thickness skin graft (STSG), possibly leading to secondary infections of transplanted wounds. Applying nonadherent antimicrobial dressing with silver sulfadiazine cream or gentamycin ointment as well as water-filtered infrared-A (wIRA) may help decrease infection rate at donor site donor sites.
Tissue donation involves extracting vitalized tissues and organs from living or deceased donors for medical and surgical use. Donation takes place following an extensive medical evaluation, family and social history information and an inspection to ensure no signs of disease exist in their bodies.
To donate organs, eyes or tissues safely, individuals must register with an accredited tissue recovery organization and gain approval by their legal next of kin. Donors must also undergo testing for HIV, Hepatitis B/C, Syphilis and any blood- or hematopoietic stem-cell donors must undergo T-lymphotropic virus and Cytomegalovirus (CMV) infections before giving their donation.
For maximum graft efficacy, it is critical that the donor site heals properly. Newly healed sites may become dry and itchy after healing has completed, leading to scratching that causes further trauma to the graft. Patients should be advised against scratching grafts while prescribed skin emollients to soothe itching; oral antihistamines may also help limit itching; however, use of such medicines under physician supervision is advised as their use could potentially cause drowsiness.
Tissue donors may require the use of a bolster or vacuum bandage to keep the graft secure and help the wound to heal more rapidly. Regular changes to this wound dressing will keep it looking clean and dry.
