Trans Health Care, Medicaid and the Shortfalls of Prison Re-Entry Services

September 25, 2023

For about three weeks, I’d been communicating smoothly with the clinic where I’m scheduled to undergo breast augmentation surgery and body fat transfer. I’d provided the medical clearances requested of me, and put down a $1,000 deposit.

Then they realized I’m transgender.

Gender dysphoria, I was told, meant I had to produce a psychiatric clearance from my mental health provider. My surgery date was less than a month away, and if I couldn’t get the psychiatric clearance within a week, I’d lose my $1,000 deposit.

I don’t have a mental health provider. Thankfully, I was able to find a licensed social worker to interview me and write a letter confirming that I’ve lived with gender dysphoria for over a decade and that the decision to operate on me was sound.

“Christina meets and exceeds the criteria as set forth by the World Professional Association for Transgender Healthcare and is capable of making an informed decision about undertaking surgery,” she wrote. “Her judgment appears sound and good.”

I count my blessings that I was able to find someone to write such a letter on short notice, but my capacity to make informed decisions about my health shouldn’t come into question on the basis of my being trans. When I was initially assumed to be a cis woman, no one needed a third party to tell them my judgment was sound and good. I was trusted to say so on on my own behalf. My desire to feminize my body—that is, to bring it closer to my ideal of what I, as a woman, want to look like—wasn’t of concern.

Gender-affirming care in Georgia became Medicaid-eligible in 2022, but I’m paying for my procedures out of pocket.

The main reason I don’t have a mental health provider is that at the time I was informed of the psych clearance, I’d been released from a 13-year prison sentence just a few days earlier. Not only do I not have any health care providers, I don’t have any health insurance.

Gender-affirming care in Georgia became Medicaid-eligible in 2022, but I’m paying for upcoming procedures out of pocket. I applied to Medicaid as soon as I was released, but have yet to receive a response. 

While still incarcerated, I’d asked corrections staff about applying to Medicaid and SNAP and other government assistance programs. I was told I’d have to wait until after I got out. I know other prisoners who’d had my same security classification, and had gotten their applications started while still inside.

I mentioned qualifying for emergency relief funds, citing the Georgia Inmate Bill of Rights housed in prison’s law library that instructed me to apply for Supplemental Security Income (SSI) assistance 90 days before my release date. I was told I’d need to take it up with Social Security at a later time.

On paper, you’d think I was collecting thousands of dollars per month from a dozen different kinds of checks.

I’ve been locked up my entire adult life, and at no point in those 13 years did I ever come across any resources related to gender-affirming care. Medicaid and CHIP Payment and Access Commission’s current guidance on Medicaid access for adults re-entering the community after incarceration does not include any information on the subject.

In the lead-up to my release, not only was I not provided any linkages to outpatient providers to continue my hormone replacement therapy (HRT)—initially I was told I couldn’t even take with me the doses that were already on-hand. Everything I gained access to in prison, including HRT, I had to litigate for in the first place.

The Inmate Bill of Rights also told me that upon release, I should head to the nearest Social Security Office and show my release paperwork to receive a $1,500 SSI and Emergency Supplemental Benefits check within 72 hours. Go to the nearest Welfare office and do the same, and I’d receive another check for “approximately” $1,500 within two hours. As someone formerly incarcerated, I qualify as a minority, and am eligible to receive $340 per month for three months. And so on.

The procedures I’m scheduled for are urgent.

On paper, you’d think I was collecting thousands of dollars per month from a dozen different sources. In real life, of course, I’m stretching a McDonald’s salad across two or three meals while pouring my savings into surgeries out of pocket.

The procedures I’m scheduled for are urgent. Every gender nonconforming person has their own perspective on “passing”—mine is that the more I pass as a cisgender woman, the more employable I am. It should also go without saying that passing makes me safer, especially as a trans woman of color in the South. Delaying these procedures due to lack of funds would mean delaying my ability to get a decent job in customer service, or just to take a walk outside without fear.

“All felons should apply and insist on receiving the benefits available to them,” reads the Inmate Bill of Rights. “You may be denied 3 or 4 times but keep persisting.”



Image via Georgia Department of Community Supervision

C Dreams

C is a writer and advocate interested in prison/criminal justice reform, LGBTQ rights, harm reduction and government/cultural criticism. She has studied history/theology with the Third Order of Carmelites and completed degrees in Systematic Theology. She is currently studying law.

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