HHS Lifts Medicare Ban on Gender-Confirming Surgeries

The U.S. Department of Health and Human Services will begin offering transition-related healthcare coverage to transgender Medicare beneficiaries.

BY Parker Marie Molloy

May 30 2014 12:13 PM ET

The U.S. Department of Health and Human Services announced today that Medicare's blanket exclusion on gender-confirming surgeries is to be removed, declaring that the decades-old policy runs contrary to contemporary scientific and medical standards of care.

In a joint statement from the American Civil Liberties Union, the National Center for Lesbian Rights, and Gay & Lesbian Advocates & Defenders heralding the news, the organizations write:

“This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare. It is consistent with the consensus of the medical and scientific community that access to gender transition-related care is medically necessary for many people with gender dysphoria. The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition-related surgeries denied. They should either get coverage or, at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment.”

The legal groups brought the challenge to Medicare's trans-exclusive policy on behalf of transgender woman and Army veteran Denee Mallon. "This decision means so much to me and many other transgender people," the 74-year-old Mallom said in a statement today. "I am relieved to know that my doctor and I can now address my medical needs, just as other patients and doctors do."

Immediately following the ruling, the National Center for Transgender Equality released a fact sheet to answer some of the expected questions and concerns, clarifiying that today's ruling does not impact Medicaid, and noting that existing Medicare beneficiaries may not see an immediate change in their surgical coverage options.

"At present, many providers of transition-related procedures may not accept Medicare coverage," reads NCTE's fact sheet. "Because this care has always been categorically excluded from Medicare in the past, patients may encounter challenges at first in finding an appropriate provider who will accept Medicare coverage. We hope and expect that, over time, the number of qualified providers accepting Medicare will grow."

"Today's ruling represents the medical community's clear understanding that gender dysphoria is a serious medical condition, and the government should not stand in the way when doctors recommend treatment," said NCTE executive director Mara Keisling in a written statement. "This ruling comes from an independent panel who've studied the science on transgender healthcare. Today, this panel ruled that Medicare cannot flat-out exclude medically-supported treatments for transgender people."

"Science and fairness are winning over outdated biases," continued Keisling. "NCTE will continue to advocate for access to medically necessary care for all transgender people."

This news comes as an increasing number of states mandate the coverage of transition-related care in public and private insurance policies.

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