Effect of Medicaid Expansion on the Crowdfunding Behavior of Transgender Adolescents

Abstract

While some states in the USA have increased access to medical transition through mandating the services’ inclusion in their Medicaid expansion and tying in policy mandating transition-related care in private insurance plans, other states have chosen not to. Along with other factors, this uneven expansion has encouraged transgender adolescents to turn to crowdfunding to raise money for transition-related care. This ecological descriptive study compared trends in states with a Medicaid expansion that included access to medical transition for transgender adolescents to those that did not, through the lens of crowdfunding practices used to pay for a variety of transition-related healthcare costs. There was a proportionally higher number of transgender people conducting crowdfunding campaigns in states where Medicaid does not mandate access to a standard set of procedures for transgender people under 18 (unmandated state) than states where Medicaid does mandate access to a standard set of procedures for transgender people under 18 (mandated state). In the total sample of 98 cases, 60% (n = 59) were from unmandated states, while 40% (n = 39) were from mandated states. A surprising finding of this study was the prevalence of campaigns from mandated states. While access barriers previously discussed in the literature can account a great deal of the campaigns, an individual’s ability to work healthcare systems to their advantage, termed savvy in this paper, may account for the other cases. Transgender adolescents may need special outreach to educate them about their ability to use Medicaid to pay for transition, and guidance through overcoming access barriers to do so. Healthcare navigators skilled in the needs of transitioning adolescents are a worthy avenue for future policy development and funding.