Medicare Lifts Transgender Surgery Coverage Ban

Transgender people receiving Medicare may no longer be automatically denied coverage for sex reassignment surgeries, a U.S. Department of Health and Services review board ruled Friday in a groundbreaking decision that recognizes the procedures as a medically necessary and effective treatment for individuals who do not identify with their biological sex.

Ruling in favor of a 74-year-old Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency's Departmental Appeals Board ruled that a three-decade-old HHS rule excluding such surgeries from the procedures covered by the national health program for the elderly and disabled was unjustified.

"Sometimes I am asked aren't I too old to have surgery. My answer is how old is too old?" the veteran, Denee Mallon, of Albuquerque, New Mexico, said in an email interview before the board issued its decision. "When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."

Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government. Instead, the lifting of the coverage ban means they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals stating that surgery is medically indicated in their individual case, Levi said.

Transgender health advocates believe the decision could eventually pave the way for sex-reassignment surgeries to be a routinely covered benefit by private insurance.

No statistics exist on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at UCLA, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.

The ruling does not apply to Medicaid, which provides health coverage for individuals and families with low-incomes and is regulated by the states.