Nova Scotia begins covering breast reduction surgery for non-binary people

Nova Scotia Medical Services Insurance (MSI) has begun covering breast reduction services for non-binary individuals.

In a physician's bulletin on Nov. 4, MSI said the Department of Health and Wellness "has added the diagnosis of Persistent and Well Documented Gender Dysphoria to the list of criteria for MSI coverage for a breast reduction." 

The change, effective Nov. 2., came following a complaint last fall to the Nova Scotia Human Rights Commission from Sebastian Gaskarth, who is non-binary.

In an interview, Gaskarth, who uses they/them pronouns, said they were "relieved" about the change in coverage. 

"I'm really happy about it," said Gaskarth. "I'm so glad to see it on their website and that others will look at it and be like, 'This finally is here.' 

"And it just affirms who I am as a person and for [whoever] else needs the surgery as well."

Non-binary refers to a spectrum of gender identities that are not exclusively masculine or feminine.

Gaskarth, 33, first began working with the Dalhousie Legal Aid Service in the spring of 2019. The complaint was filed to the human rights commission that fall after they were denied coverage for the surgery, which they ended up paying for out of pocket.

Beyond the binary

Previously, gender-affirming surgery in Nova Scotia covered chest masculinization and mastectomy surgeries for transgender men, and breast augmentation for transgender women. 

Gaskarth said that not only does the new coverage mean that non-binary people can access gender-affirming surgery, it also means MSI has recognized that gender does not exist as a binary.

"Which is huge, which will hopefully propel MSI and other organizations to start to be more inclusive and to see things beyond the binary," they said.

Gaskarth said they would like to see the health-care system embrace an informed consent model, which would mean a move away from strict eligibility criteria and toward more flexibility.

Mark Culligan, a community legal worker with Dalhousie Legal Aid, described MSI's move to cover non-binary people seeking breast reduction surgery as a "real milestone."

"The previous coverage was based on the understanding that transitioning happens from male to female, from female to male, and what was unique about Sebastian's case was that they were asking for a surgery that more accurately reflected their identity as a non-binary individual," he said.

"It's a change to coverage that specifically recognizes that experience and those needs."

The province began covering breast augmentations for transgender women last year following a human rights complaint from Serina Slaunwhite, who was denied breast implants in 2017 on the grounds that the surgery was not medically necessary. Dalhousie Legal Aid was also involved in that case.

Culligan said MSI has slowly expanded its coverage in response to human rights complaints in recent years.

"We wish that MSI was a little bit more proactive about identifying what surgeries are needed and where gaps in the current coverage exists ... but I think it is at least a positive thing that MSI is moving forward to expand coverage piece by piece," he said.

In a statement, Department of Health and Wellness spokesperson Sarah Levy MacLeod did not confirm if the change to MSI was because of Gaskarth's complaint, but said "we appreciate those who have highlighted the need for changes like this one."

"This change provides more support to Nova Scotians who identify as non-binary and more equitable coverage for everyone," said Levy MacLeod.

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