. > Date: Fri, 10 Nov 1995 17:46:15 -0500 (EST) > From: "Kristine W. Holt" > Subject: Pennsylvania DPW policy regarding TG medical benefits > > TO ALL: > > First, a few pieces of general information. > > The individual who is implementing the DPW policy is John F. > Ferrara, Director, Division of Provider Assessment. The contact > person in his office is Grace Miller 717-772-5308. Addresses > will follow when I get them. > > Mr. Ferrara is basing his denial of benefits to TG people on > the basis of 55 Pa. Code section 1141.59(11), and > alternatively, 55 Pa. Code section 1126.54(a)(7). Both of > these regulations have been in effect since 1989, at least; > however, they have only been selectively enforced up until now. > Any doctor who has been providing care to TG's is in real danger > of having a *big* liability assessed against her/him. These DPW > regulations violate federal Medicaid statutes and regulations, > which prohibit denial of benefits on the basis of diagnosis > alone. > > After conference with a few people, the following course of > action has been suggested, and is offered for discussion: > > I plan to file an administrative appeal, pursuant to state > regulations, on the denial of services my doctor received. *I > do not believe this will solve the problem!* However, it will > preserve the issue in appeal status, so that the opportunity to > challenge it in the courts later, if need be, is not lost. We > have a "window of opportunity" open here through which we can > successfully challenge the Pennsylvania DPW regulations, just as > was done in California, Minnesota, Iowa, and Georgia. If we > have a consensus of action, this is a suggestion of what we need > for the long term (6 - 12 months): > > a. Contact with legal professionals willing to advocate for us. > We need, particularly, an attorney or legal team who is familiar > with the federal system and class action suits. We should also > have a network of paralegals and students willing to do the > necessary research and drafting, if we want to get an action > under way. (I have precedent cases which can serve as a > starting point, or, if you will, a recruiting lever.) *THIS IS > A DO-ABLE THING!!!* It's been successfully done in other > jurisdictions. > > b. A database of other TG people who have been similarly > affected by DPW policy. This would be essential for sustaining > a class action suit. Everyone, talk to whoever you know that is > receiving DPW benefits, has received them in the past, has been > turned down for benefits, has had benefits restricted, etc. Get > names and details! > > c. A source of medical, psychiatric and psychological experts to > provide testimony as to the need for continuing medical > treatment for transgender people. Perhaps SRS surgeons who > would testify as to the efficacy of surgery? Statistics on > suicide rates of untreated TGs? Quality of life, employment > ability, concurring psychiatric problems (i.e., depression, > substance abuse, etc.)? Established medical standards vs. > experimental procedures? Prevelance in the general population? > Any other possible issues? > > d. An effort to get DPW to re-examine their policy toward TG > people and reverse it, in light of federal Medicaid regulations > and court holdings in other jurisdictions. What leverage do we > have, other than threat of federal suit? Does anybody know > whether we can *force* a re-hearing on agency regulations, short > of legal action? > > e. Obviously, a public relations effort. It seems essential > that we go on the offensive from the start, defining the issue > and spinning it our way from the very first shot, rather than > letting our opponents get in the first hit, leaving us in a > defensive position. Up front and honest about our motives and > actions -- our cause is noble, and can stand the "is it the > right thing to do?" test!!! > > f. A coordinator for all the above. Could this be through the > net, through personal meeting, or how? Delegating functions, > assembling all the components, directing the show. Right now, > we're looking at a technically "Pennsylvania" issue, although > I'm sure there could be plenty of input from national sources, > particularly those states where this has been done already. > Probably this would coincide with (e), as it'll be necessary to > publicize the effort through our own community, via newsletters, > journals, etc. > > This is something we, as a community, must do together. It > cannot be carried out by one, two, or even five people alone. > *I* certainly will not do it!!! As with everything in life, > it's necessary for us to take whatever action necessary to > minimize the effect adversity has on each of us personally. > This situation is no exception; I intend to act accordingly, as > should we all. BUT -- many of us are limited in our ability to > withstand the "slings and arrows," while others among us have > the needed talents and resources. "From each according to their > abilities..." If we can't work beyond our own individual needs > and pull together as a community, we WILL deserve everything > that gets heaped upon us. IF WE WON'T LOVE US, WHO WILL??? > > Everyone knows what they love best -- LET'S DO IT!!!!!!!!!! > > Looking for ideas, feedback, criticism, damnation -- discussion. > > KRISTINE W. HOLT