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51 Colum. J.L. & Soc. Probs. [i] (2017-2018)

handle is hein.journals/collsp51 and id is 1 raw text is: COLUMBIA JOURNAL OF LAW AND SOCIAL PROBLEMS Volume 51 Number 1 Fall 2017 Copyright C 2017 by the Columbia Journal of Law and Social Problems, Inc. BEYOND CATEGORICAL EXCLUSIONS: ACCESS TO TRANSGENDER HEALTHCARE IN STATE MEDICAID PROGRAMS...................................................................... 1 This Note addresses a major barrier to care that transgender individuals face: categorical exclusions barring payment for healthcare related to gender transition in state Medicaid programs, along with policies prohibiting payment for such care when deemed cosmetic. It first argues that because the dysphoria and discrimination that transgender individuals experience affect their quality of life and mental well-being, and derive from a discord between their appearance and gender identity, those considerations should be taken into account in the legal determination of medical necessity. As medical studies and the views of major medical associations demonstrate, healthcare for gender transition has been found medically necessary for some individuals to mitigate their gender dysphoria. This Note then describes the arguments for and against the invalidity of categorical exclusions and other policies that deny transgender individuals access to medically necessary care, focusing on Section 1557 of the Affordable Care Act as well as more general provisions of federal Medicaid law. It then examines these issues in the context of litigation regarding New York's limitations on transgender healthcare, which ultimately culminated in a medical necessity standard. Finally, it considers the arguments that Medicaid coverage for gender transition would be too costly, and that requiring states to cover such care would undermine principles of federalism. TIME OF DESPERATION: AN EXAMINATION OF CRIMINAL DEFENDANTS' EXPERIENCES OF ALLOCUTING AT SENTENCING........... 39 For criminal defendants, allocution is the last time they may address the court before sentencing is pronounced. For many defendants, whether because they pled guilty or did not testify at trial, it is their only such opportunity. According to a recent survey of federal judges, allocution at sentencing can, for better or worse, significantly affect sentencing decisions. Other researchers have suggested that, beyond such effects, allocution is also important in creating opportunities for defendant expression that go beyond the presentation of mitigating information. Despite the impact of sentencing, little research has been done into defendants' perspectives on their own allocutions. This Note draws on interviews to explore the ways in which defendants prepare for and experience their allocutions, and situates their rationales for allocution within the existing literature. Part II provides background information on how allocution has been treated in the courts. Part III discusses the Note's interview methodology. Parts IV and V respectively examine the humanization and mitigation rationales for allocution from the perspective of defendants, and conclude that it is the mitigation rationale that more accurately reflects the accounts given by defendants.

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