CHICAGO (CBS) — He was the first openly transgender person to enlist in the U.S. military, then an injury during basic training forced Liam Papworth-Rodriguez, of Chicago, to discharge. He’s fighting a new battle these days.
CBS 2 Morning Insider Lauren Victory details a campaign for insurance coverage.READ MORE: Woman Critical, 1 of 6 People Wounded In Lawndale Mass Shooting
Papworth-Rodriquez opened up about his 13-year journey.
“It was something that made me happy for the first time,” he said of his transition to becoming a man, which began with testosterone shots.
Years later, he went under for a mastectomy, followed by a hysterectomy last fall. This spring, he planned to be done.
“I am so distressed and uncomfortable in my body,” he said.
But scheduling his final gender-affirming surgery hit several snags starting in January; from a months-long dispute with one hospital, to battling for insurance coverage at another.
Finally, in May, Medicaid provider IlliniCare gave the green light.
“I was so excited. I was like, ‘Okay, maybe this is actually going to happen this time,’” he said.
Then came weeks more of back and forth with insurance over who would pay for his required electrolysis, which easily cost several thousand dollars.
“I’ve been exhausted. I have had days where I feel like I can’t keep fighting this,” he said.
The thing is, he shouldn’t have to fight.READ MORE: Young Woman, 18, Dies After Being Shot In West Elsdon
Gov. JB Pritzker expanded Medicaid coverage to include gender affirming surgery more than a year ago. So why all the hold-ups?
Papworth-Rodriguez said he believes he’s one of the first people to test the policy.
“The waiting has been the worst part,” he said.
Illinois State Rep. Greg Harris (D-Chicago) worked on this case. He said he thinks the state’s managed care organizations need to reevaluate the handling of transgender health, review their network of providers, and educate their claims specialists.
Papworth-Rodriguez offered a solution, too.
“I would really like to be involved in writing policy for the state,” he said. “We shouldn’t have to fight tooth and nail, every step of the way to get the care that the state of Illinois law says we are entitled to.”
Papworth-Rodriguez is officially scheduled for a consultation with a surgeon next week.
The Illinois Department of Healthcare and Family Services couldn’t discuss his specific case, but a spokesperson said DHFS is working with the LGBTQIA community to educate providers about last year’s policy change.
“Rules to implement gender affirming surgery were adopted late last year by the legislature’s rule making body, and the department immediately began informing Medicaid providers of this coverage. It includes all gender-affirming surgeries, services and procedures medically necessary to treat an individual’s gender dysphoria. These are described in a range of materials for providers. Among these are breast/chest surgeries, genital surgeries, and related therapies.
Helping providers, members and our managed care health plans understand new guidelines is a crucial part of the process whenever coverage is expanded. The department and health plans have been reaching out through notices to providers, FAQs and direct engagement with providers about specific questions and cases. In addition to providers and the health plans, we are working with stakeholders and the LBGTQIA community to continually educate providers on this coverage. The department is committed to helping those facing gender dysphoria with access to compassionate and comprehensive treatment. As far as specific data, we are pulling information on coverage and will provide it to you as soon as it is available.”MORE NEWS: Chicago Fire Paramedic's Cap Grazed At Stroger Hospital; Man Killed In Shooting Nearby
Officials said stakeholders are meeting “regularly.”