SANTA FE, N.M. — A Republican state senator is questioning a new state insurance order that could require New Mexico to help pay for certain gender-transition procedures and prescriptions covered by private health plans, days after criticizing a separate decision to use state money to continue covering similar treatments for minors enrolled in Medicaid.
Sen. Gabriel Ramos, R-Silver City, raised the latest concerns Monday over an Aug. 10 order from the New Mexico Office of Superintendent of Insurance establishing which “sex trait modification” procedures, diagnoses and prescriptions will be eligible for state defrayal beginning with 2027 health plans sold through the BeWell insurance exchange.
The dispute involves two separate funding mechanisms. The insurance order applies to certain private plans sold on New Mexico’s health insurance exchange, while Ramos’ earlier criticism focused on the Health Care Authority’s plans to continue coverage for gender-transition treatments for minors using state funds after new federal Medicaid and Children’s Health Insurance Program restrictions take effect.
Under the insurance order, carriers may seek defrayal from the state for medically necessary services covered under New Mexico’s rules. The list includes mastectomies, breast augmentation, hysterectomies, removal of ovaries or testicles and genital reconstruction procedures, as well as estrogen and testosterone therapies. It also includes the diagnostic code for “gender identity disorder of childhood.”
The order does not establish age limits for the listed procedures or say that every listed service would qualify in every case. Claims must be considered medically necessary and meet the state’s requirements.
OSI said the order implements an emergency rule adopted in May and reflects New Mexico laws protecting people seeking medically necessary sex-trait modification procedures from discrimination. The agency said the order determines which claims can qualify for defrayal and may be revised as medical practices change. It is scheduled to expire Dec. 31, 2027, unless renewed through subsequent agency action.
Ramos argued the policy raises questions about both public spending and oversight.
“First it was Medicaid, and now it’s the individual insurance market too,” Ramos said in a statement. He said he plans to seek a full accounting from OSI of the projected cost to the state and push for legislative oversight before the 2027 session.
The criticism follows an Aug. 25 statement from Ramos opposing plans by the New Mexico Health Care Authority to continue using state funds for gender-transition treatments for minors once federal funding is restricted. The treatments cited by Ramos include puberty blockers, hormones and related services.
The Centers for Medicare & Medicaid Services finalized a rule in August ending federal Medicaid funding for specified gender-transition procedures for children under 18 and CHIP funding for those services for people under 19. The rule takes effect Oct. 13, although federal funding for some patients already receiving hormone therapy can continue temporarily. Mental health services are not affected.
Ramos said taxpayers should not be required to finance treatments they may oppose on medical, moral or religious grounds.
“This isn’t about judging any family going through a hard situation,” Ramos said. “It’s about whether state government should be forcing the rest of us to fund something so many New Mexicans believe … is simply wrong to do to a child.”
