Importance Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy's medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.

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变性和性别少数族裔患者永久脱毛的健康保险。

重要性对于外观不符合其性别身份的少数族裔（GM）患者，脱毛可能是性别确认过程的重要组成部分。目的研究《平价医疗法案》（ACA）市场上的健康保险政策以及针对变性者和GM患者永久性脱毛的医疗补助政策，并将每个州的政策与全州范围的性别确认护理覆盖率相关联。设计和设置ACA市场上可用的私人健康保险保单和全州医疗补助保单在2019年9月1日至10月31日和2020年1月17日至30日的横断面研究中进行了评估。评估了永久性脱毛的保险范围。在每个政策中都找到了有关脱毛的语言。的医疗或临床保险指南，分为一般类别。主要结果和措施进行了Logistic回归分析，以比较有或没有跨性别保护的州的医疗补助政策和ACA政策。结果共分析了174份保单，其中123份私人保险单和51份全州医疗补助单。在这些政策中，有8个（4.6％）允许无永久限制地永久性脱毛。其余166项政策（95.4％）广泛排除或未提及确认性别的护理；禁止覆盖脱毛或没有提及；或仅允许在生殖器手术前进行脱毛手术。与没有保护措施的州相比，没有跨性别护理保护的州的ACA市场政策覆盖无限制脱毛的可能性要比有保护措施的州的ACA政策（无保护政策的州中有85项政策中的2项[2.4％]与38项政策中的5处[13.2％]）在具有跨性别护理保护的州），与ACA政策相比，Medicaid政策不太可能覆盖术前或非手术性脱毛（51个Medicaid政策中的6个[11.8％]，而123个ACA政策中的47个[38.2％]）。结论与相关性尽管一些州在全州范围内对转基因医疗的排除采取了限制措施，但本研究中研究的大多数医疗补助和ACA政策并未涵盖变性患者的永久脱毛。许多寻求脱毛的GM患者可能需要自付费用，