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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: 


                 SOCIAL PROBLEMS
Volume 51                        Number 1                          Fall 2017
       Copyright C 2017 by the Columbia Journal of Law and Social Problems, Inc.

  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.


  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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