On April 25, Gov. Bob Ferguson signed into law House Bill 1971, expanding Washingtonians’ access to hormone therapy by allowing for 12-month refills for patients of all ages. But the Trump administration has recently warned states that they are prohibited from using federal Medicaid dollars for gender-affirming care, which is inclusive of hormonal therapies.

Rep. Nicole Macri (D 43) said she introduced this bill earlier this legislative session after numerous people contacted her office to express feelings of hopelessness about the Trump administration’s increasing attacks against Transgender people.

“I am grateful to my colleagues who voted to move this important health care protection law. Regardless of the assault on Transgender rights at the national level, in this Washington, we protect vulnerable populations, and this bill is another way we are standing up for the Transgender community,” Rep. Macri said in a press release.

The law, which goes into effect on July 27, allows healthcare enrollees to obtain a 12-month refill of prescription hormone therapy at one time, unless that patient requests a smaller supply, or if that prescription is a controlled substance, according to the engrossed bill’s text. The law only applies to prescription hormone therapy that can be safely stored at room temperature.

“Nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a 12-month supply of the prescription hormone therapy has already been dispensed during the plan year,” according to the bill’s text. If there is a dispensing shortage of a prescription hormone therapy type during the plan year, healthcare providers can still temporarily limit such refills to a 90-day supply at one time, although those limits must be rolled back as soon as a regularly reinstated supply of the medication becomes available.

HB 1971 defines prescription hormone therapy as all US FDA-approved drugs used to medically suppress, increase, or replace hormones that a person’s body is not producing at intended levels, and does not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.

On April 11, Drew Snyder, deputy administrator and director of the federal Department of Health & Human Services, issued a letter to state Medicaid directors, claiming that treatment such as gender-affirming care (puberty blockers, hormone replacement therapy, and gender-affirming surgery) “lack reliable evidence of long-term benefits for minors, and for some children, these interventions are now known to cause long-term and irreparable harm.”

The state’s Health Care Authority (HCA) told the SGN that it closely monitors federal actions and coordinates with the Office of the Governor and the Attorney General’s Office to review any potential impacts.

“As of now, no new federal rules or mandates have been issued that affect Medicaid coverage of gender-affirming care, and [there] have been no changes to our policies or services,” said Katie Pope, the HCA’s deputy chief communications officer.

Rep. Macri told the SGN that it’s unclear if the Centers for Medicare & Medicaid Services will deny any federal Medicaid matching payments to states for gender-affirming care that is medically necessary, but that Apple Health members’ access to such care is protected under state law.

“Democrats here in Washington are continuing to ensure that our state laws protect individuals and expands their access to care, and we will continue to fight back against federal action which discriminates against our residents,” Rep. Macri said.

Rep. Macri noted how in 2021, the legislature passed the Gender Affirming Treatment Act to protect the rights of insured people seeking such medical treatments.

“Under the law, commercial insurance companies regulated by the Office of the Insurance Commissioner and the state Health Care Authority [Public Employee Benefits, School Employees Benefits, and Apple Health (Medicaid)] cannot exclude, deny, or limit medically necessary gender- affirming treatment and must provide access to medically necessary gender-affirming treatment,” Rep. Macri added.

Last year, Apple Health expenditures for gender-affirming care services totaled just under $11 million, with about $8.7 million coming from federal resources, according to Pope.

“As a member of the House Democrats’ budget-writing team, the potential loss [of] federal funding is something I’m tracking closely on several fronts,” Rep. Macri said. “Legislators will continue to work closely with Gov. Ferguson and Attorney General Brown to respond to federal funding cuts.”

Rep. Macri said she is proud to stand up for Trans Washingtonians, with HB 1971 being one way to protect their access to lifesaving care.