Funding leaves large gaps for trans health

Electrolysis coverage goes from patchy to non-existent

Following their transition path just got even more expensive for many trans people in Manitoba.

Jocelyn Mallette, a non-binary member of TransManitoba, says “the Trans(gender) Health Klinic sent a letter to all of their patients that said that they couldn’t find a service provider (for electrolysis) in Winnipeg that met the requirement(s for funding).”

Electrolysis is a kind of hair removal process “when laser isn’t efficient enough,” Mallette says. “Sometimes it’s people’s transition path that they choose to do, but if their transition path involves surgery at all, often it’s a requirement or else (it) causes a lot of complications.”

The Transgender Health Klinic is part of Klinic Community Care and is a primary provider of health services for
trans people in Winnipeg.

Allison Fenske, a lawyer with the Public Interest Law Centre who works on cases of barriers to medical services for trans people, says “the Province is prepared to fund as an insured health service electrolysis for trans folks where it’s medically necessary,” but that for services like electrolysis to be covered, they “need to be provided by a medical practitioner, in this case, a doctor.”

“That creates a barrier for folks, because, as we know, this is not a service that’s typically provided by doctors,” Fenske says. “This is something often provided by trained estheticians and individuals who are not licensed medical doctors but who are trained to provide electrolysis and laser therapy.”

“A lot of people see it as ‘why can’t any of the providers that exist right now be able to provide that service?’” Mallette says. “But there’s also only one laser hair-removal office in Winnipeg that does it, and they sort of have a monopoly on it, because they have the one doctor there.”

Mallette says for a while, “people were getting approved for it, and TransManitoba talked to Klinic about getting a diagnosis in-house, and so a few people saw a doctor in Klinic on Portage for electrolysis, but then (the Manitoba Government’s Department of Health, Seniors and Active Living) stopped funding them.”

“They met the requirements, but then it still wasn’t enough for funding to be approved,” Mallette says.

Fenske says many health services for trans people get covered in ways that are patchy and inconsistent and put an intense financial burden on trans people that other patients requiring medically necessary treatments do not face.

“And then there’s the issue that of the services that are covered aren’t available within the province, so it requires travel out of the province, typically to a specialized clinic in Montreal,” Fenske says.

“Manitoba Health has an out-of-province transportation subsidy (for these patients), but only covers your air or care travel back. It doesn’t cover other ancillary expenses like hotel accommodations if its an outpatient surgery or hotel accommodations if you have a support person travelling with you, meals, that sort of thing,” Fenske says.

She says even for covered services, “they’re often required to pay out of pocket and seek reimbursement later.”

Mallette says aside from the cost of getting electrolysis privately, which can already be from thousands to hundreds of thousands of dollars, there are plenty of other unnecessary barriers, such as required psychological exams and finding the right doctors who are willing to help trans patients.

“I think they just need to allow the requirements to be more lenient so that funding for people who can provide the service in Winnipeg can make it more widely available.”

Published in Volume 73, Number 8 of The Uniter (November 1, 2018)

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