Medicare Won't Yet Decide Whether to Cover Gender Reassignment Surgery

By Sunnivie Brydum

Originally published on Advocate.com April 01 2013 2:22 PM ET

The U.S. Health and Human Services Department reversed course Friday night after saying earlier that day that it would consider revising Medicare policy to cover medically necessary gender transition surgeries.

Friday morning the Center for Medicare and Medicaid Services, which runs the government's national insurance program, published an announcement on its website that it would be seeking public input on its reconsideration whether or not to cover gender reassignment surgery for people on Medicare, as The Advocate reported.

But later that same day, HHS issued a contradictory statement, and the center withdrew its request for comment on the potential policy change.

The confusion arose from an administrative challenge to Medicare's 30-year-old statutory refusal to provide medically necessary health care to transgender patients. Both Medicare and Medicaid currently prohibit all forms of gender reassignment surgery, regardless of the individual patient's diagnosis or serious medical needs. 

"An administrative challenge to our 1981 Medicare national coverage determination concerning sex reassignment surgery was just filed," an HHS spokesperson told The Hill Friday. "This administrative challenge is being considered and working its way through the proper administrative channels. In light of the challenge, we are no longer re-opening the national coverage determination for reconsideration."

The National Center for Lesbian Rights, American Civil Liberties Union, and Gay and Lesbian Advocates and Defenders filed the challenge on behalf of a transgender veteran who was denied gender-reassignment survey after her doctors determined it was medically necessary to alleviate her severe gender dysphoria

"Medicare's categorical exclusion of this care lacks any scientific basis," NCLR's legal director, Shannon Minter, said in a statement announcing the challenge. "Study after study has shown that these surgeries are the only effective treatment for many patients suffering from severe gender dysphoria."

"As a result of the administrative challenge, the Department Appeals Board of the U.S. Department of Health and Human Services must review the ban, determine whether it is reasonable based on current standards of care, and reverse it if it is not," according to the LGBT organizations' release. "Earlier last week, the HHS Center for Medicare and Medicaid Services on its own initiative included a statement on its website that it would be reconsidering the ban. [The center] subsequently withdrew its proposal to reconsider the ban and through a spokesperson explained that the ban would instead be reviewed through the independent Department Appeals Board process."

Despite the mix-up, transgender advocates are optimistic.

"What HHS did is very positive news from our perspective," said Mara Keisling, executive director of the National Center for Transgender Equality. "They haven't stopped considering coverage of sex reassignment surgery under Medicare. Instead, the Center for Medicare and Medicaid Services, which is housed under HHS, decided to use a different administrative process to change whether Medicare covers medically necessary sex reassignment surgery. What matters is that we get a fair and scientific process. We'll win that every time."