Las Vegas Sun

March 28, 2024

Health care outside the male and female checkboxes

Jackson Nightshade

Mikayla Whitmore

Jackson Nightshade, at the Gay & Lesbian Community Center of Southern Nevada, identifies as multigender and nonbinary.

Jackson Nightshade is counting down the days until open enrollment for government-subsidized health insurance begins again in November. The 28-year-old Las Vegas resident identifies as multigender, and for many years, health insurance seemed too pricey and too discriminatory. Nightshade, who recently graduated from UNLV with a master’s degree in marriage and family therapy, had insurance providers misstate gender identification and faced steep fees for hormone-therapy treatments. In June, however, Nightshade found reason to hope. The Nevada Division of Insurance prohibited insurance carriers from denying, excluding or limiting medically necessary health care services on the basis of gender identity or expression, putting Nevada in the company of eight other states as well as Washington, D.C., that have instituted similar requirements. Nightshade recently spoke to The Sunday about the impact of the change.

You don’t identify as male or female. What is your gender identity?

I identify as multigender and nonbinary. I use the transgender label, but it’s not the first term I prefer. Most people don’t know what multigender is because I came up with it myself. I’ll throw in the nonbinary to indicate I don’t identify as male or female. It sounds weird because it sounds weird in my head still, but I am some combination of both or neither gender, depending how I wake up in the morning.

How did you arrive at your gender identity?

When I was growing up, people would say, “Oh, you’re a girl.” I didn’t think about it too much. It wasn’t until fifth grade when they would separate the quote-unquote boys and girls to teach them the changes during puberty. I wondered why I had to be in the girls’ group. It wasn’t that I felt like a boy, it just didn’t seem like it was supposed to be happening to me. That began a yearslong journey to figure out, what the hell am I? When I found nonbinary identities, those fit way better.

How have insurance carriers been insensitive to your identity?

They changed my gender identification three times without my asking them. I had to fight them to get them to change it back.

You opted out of UNLV health coverage in favor of a private plan but haven’t had health insurance since your plan expired in December. Why?

Partially, it’s cost, even with the Affordable Care Act. Before my last semester in college, I used some of my student loans to pay for insurance.

Part of it is also the doctor I see takes only certain insurance plans, so I have to pick from a limited pool. I like my doctor. I’ve been seeing her for six years. It’s rare to find a medical professional who is knowledgeable about transgender issues.

You are on a regimen of testosterone. How do you pay for it?

Out of pocket. I’ve been on hormones for six years now, and when I began, I didn’t have insurance. When I finally did have insurance, it was still cheaper for me to pay out of pocket.

How do you think this decision will change that?

Options for health care are going to be broader. For the past few years, there have been a few companies that offer transgender-inclusive coverage, but those plans tend to be more expensive. I’m hoping it will become less costly.

What more needs to be done to improve the health care system?

The next step is to fix Medicaid. There are a lot of lower-income — if not homeless and poor — transgender people who have a hard time receiving medical insurance. Medicaid is supposed to be basic health care, but it still has exclusions. I’m hopeful eyes are going to start turning.

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