For years, Savannah has been a beacon for transgender people seeking gender-affirming health care. Now, that care is harder to access.
Last Thursday, Memorial Health University Medical Center abruptly canceled all gender-affirming surgeries, leaving patients in distress after executive orders aimed at transgender people. One of those patients is Indigo, a transgender man who learned from his surgical provider last week that Memorial Health had cancelled his pre-approved double mastectomy.
The hospital issued a statement citing “a responsibility to follow state and federal laws and regulations,” including age guidelines for gender-affirming care. It has not responded to The Current’s requests for further clarification of that statement, which appears to reference a Jan. 28 executive order by President Donald Trump.
That order limits what medical services hospitals can provide to “children” by cutting Medicare and Medicaid funding to health providers that offer gender transition care for anyone younger than 19. The age of majority is 18 in Georgia and 46 other states.
Indigo, who is 24 and who does not use a last name, says he doesn’t understand what the hospital policy and the executive order have to do with him as an adult. Savannah Pride Center Executive Director Michael Bell told The Current at least two other area residents also were denied care.
But it wasn’t just happening in Savannah. Transgender people also were turned away from hospitals in Massachusetts, Maryland, Washington, Colorado, and Virginia. On Feb. 13, a federal judge in Baltimore issued a 14-day temporary restraining order against the executive order in the case of PFLAG, Inc. v. Donald J. Trump. Lambda Legal Southern Regional Director Michael D. Shutt said several hospitals quickly reversed their bans on gender-affirming care. Memorial Health was not one of those.
Amid this rapidly-changing situation, here are five things people need to know about transgender medical care in Georgia.
1. What’s going on with gender-affirming surgery?
People seeking gender-affirming surgery must meet many prerequisites, including mental health evaluations and therapy to confirm the patient’s gender identity. Hormone therapy comes next, and requires an endocrinologist to watch for any medical problems, according to Emory University’s Transgender Clinic in Atlanta. Chest reconstruction, which runs from about $6,000 to $16,000 according to topsurgery.net, comes later. Unlike mastectomies for breast cancer, “top surgeries” for female to male (FTM) patients keep some breast tissue and form it into a more masculine shape.
Memorial Health has been Savannah’s only hospital where “top surgeries” as such were performed, even though the hospital says it has never had a full cross-disciplinary gender-affirming surgical program. Emory University Hospital in Atlanta does offer such care through its Transgender Clinic, half a day’s drive from Savannah.
Some doctors in the Savannah-Chatham area offer gender-affirming procedures outside of hospitals. However, outpatient facilities don’t have emergency rooms or support for more complicated medical histories. One local plastic surgeon’s office told The Current it provides gender-affirming procedures outside of hospitals if the patient’s body mass index is under 40. As for hormone replacement therapy, another care provider told The Current, “HRT continues to be available and hasn’t been affected. I have not heard of any providers locally that have stopped prescribing it.”
2. Does trans health care now rely on insurance coverage?
Transgender people cannot always rely on their insurance companies to cover gender-affirming care. Georgia Equality Deputy Executive Director Chanel Haley, who is transgender, said those who are covered must examine their insurance rider very carefully, and “do exactly by the book what they say.” Different providers may require letters from various types of mental health and medical professionals.
In 2022, three state employees and one state employee’s minor child sued the Georgia State Health Benefit Plan for preventing transgender people from accessing the same medications and procedures that non-transgender people do. The state settled for $365,000. The following year, Gov. Brian Kemp signed into law SB 140, which prohibits gender-affirming surgery or hormone replacement therapy for minors. Now some lawmakers want to end all state funding for gender-affirming healthcare, regardless of age.
Senate Bill 39 would prohibit all state employees and dependents from using state-funded health insurance for gender-affirming care, with some limited exceptions, and it would prohibit state facilities or state-employed healthcare providers from offering gender-affirming care.
Its author, Sen. Blake Tillery, alleged that state employees were seeking procedures out of state using Georgia tax dollars. However, he did not cite any examples. A Senate press officer told The Current Tillery was in committee and unavailable for comment Thursday.
Other pending bills, like SB 30, would outlaw any gender-affirming hormonal or surgical treatment for minors, including puberty blockers, and SB 185 would ban nearly all gender-affirming care for state prison inmates, with limited exceptions, while allowing hormone replacement therapy only to reverse treatment to the inmate’s assigned sex at birth.
Insuror Blue Cross Blue Shield is already facing a lawsuit in Georgia. On Feb. 4, the U.S. Court of Appeals for the 11th Circuit heard oral arguments in the civil rights case of Houston County Sheriff’s Deputy Sgt. Anna Lange. Noting that many Georgia state employees also are covered by BCBS, Haley said, “They would have frozen [gender-affirming treatment] anyway because they’re in litigation.”
Bell and Indigo said Indigo’s current insurance carrier is Blue Cross Blue Shield, and that Indigo had gone through two previous insurers before finding coverage that he thought would work for him.
If your hospital or insurer has denied your treatment, Haley said, the first step is to file a complaint with the entity denying your procedure. The applicant should get a “denial letter,” not just a phone call — and “hang onto every piece of paper” related to your medical care and complaint. Patient grievance forms can be found on the hospital’s or insurer’s websites.
3. How can trans people pay for gender-affirming care?
About 1 in 3 transgender people are living in poverty, according to a new study by the National Center for Transgender Equality. That study found that, of 92,000 respondents, 34% are living in poverty, and 26% have had problems with insurance coverage. About 1 in 3 had experienced some form of anti-trans prejudice, including in healthcare settings.
Many transgender people pay out of pocket, whether or not they are financially secure, earning money any way they can or by seeking donations. Some surgical practices accept monthly payments, including through CareCredit, depending on the patient’s credit score and the line of credit extended to them. That line of credit might cover only part of the total cost of surgery. GoFundMe allows transgender people to set up online fundraisers to pay for gender-affirming treatment and surgeries.
Point of Pride takes applications once a year for direct financial assistance to people 18 and older who can’t afford gender-affirming care. This involves an application process and, for finalists, additional writing and interviews for limited funding.
4. What are advocacy groups doing to help?
Groups like Savannah Pride Center offer counseling, support, and connections to additional resources for the local LGBTQ+ community. It’s also sponsoring a free community health summit at the Savannah Civic Center on March 1 and 2. Georgia Equality advocates for LGBTQ+ people at the Georgia Assembly, while Lambda Legal handles court cases that apply to LGBTQ+ people as a class. Georgia Legal Aid explains how to change a person’s name and gender marker in their county Superior Court and at the Georgia Department of Driver Services.
5. What other health and mental health resources are available for trans people?
The Trans Lifeline offers a wealth of information and crisis support from trans people, in English and Spanish, from 1 p.m. to 5 p.m. Eastern time at (877) 565-8860 and online at www.translifeline.org .
Outcare Health maintains a national database of LGBTQ+-affirming care providers. However, some of its advice from November on updating passports and gender markers is outdated. The U.S. State Department has stopped updating gender markers based on another executive order. Existing valid passports with “X” as sex marker remain valid as of publication.
Out2Enroll.org offers help finding coverage and challenging coverage denials.
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