HHS Expected to Lift Medicare Ban on Gender-Confirming Surgeries

Medicare's 33-year-old ban on transition-related surgery for transgender Americans may soon be coming to an end.

BY Parker Marie Molloy

May 08 2014 5:11 PM ET

It's expected that the United States Department of Health and Human Services will call for an end to Medicare's blanket ban on sexual reassignment surgery, BuzzFeed reports.

Advocates for trans-inclusive health care are eagerly awaiting the ruling from an independent HHS panel formed last year, charged with determining whether the 1981 Medicare guidelines banning coverage of gender-confirming surgeries remains accurate on a medical level.

Since 1981, Medicare's official policy has been to deny any and all requests to cover gender-confirming surgeries, claiming that these procedures are "experimental."

"Transsexual surgery for sex reassignment of transsexuals is controversial," the guidelines directing the Centers for Medicare and Medicaid Services currently read. "Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered."

Advocates for trans-inclusive healthcare argue that the 33-year-old science serving as the basis of the ban is outdated. The American Medical Association has offered support for "public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient's physician." The World Professional Association for Transgender Health, largely considered to be the industry leader in determining best practices for clinical treatment of transgender people, notes that "hormone therapy and surgery have been found to be medically necessary to alleviate gender dysphoria in many people."

While a number of states have moved to require private insurance companies to cover transition-related care, a favorable ruling would have a wide-ranging impact that could especially benefit those trans individuals who are unable to meet the financial burden associated with gender-confirming surgeries.

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