Medicaid officials are taking steps to end publicly
funded sex-change surgery. However, the state is required to
pay for at least two more operations and will continue
to cover hormone treatment and psychotherapy for
low-income people diagnosed with gender-identity disorders.
A state appeals board ordered Medicaid last
month to pay for two people to travel out of state to
undergo sex-change operations. Estimated cost: $50,000
to $60,000 each.
The Department of Social and Health Services,
following a state audit and criticism from some
legislators, wants to halt the practice in favor of
cheaper and less controversial treatment. "This is very
controversial and in need of clarity," state Medicaid
director Doug Porter told The Seattle Times. "We've
decided to make it real crystal clear that it's not a
Instead of surgery, the state will offer other
services, such as hormone treatment and psychotherapy,
for those diagnosed with gender-identity disorders.
"We understand this is a very real condition for some
people," Porter said. "We just think psychotherapy and
hormone treatment is a better way to go."
Many transgender people and medical experts who
treat gender-identity disorders disagree. In some
cases, they argue, surgery is the only effective treatment.
"It's the only thing that repairs our mental
health and makes us feel whole and able to get back on
track," said "Lee," one of the two patients who won on
appeal last month. She requested that her full name
not be used.
Lee, 51, said she has been undergoing hormone
treatment and living as a woman for the past six
years. She is scheduled to undergo sex-change surgery
this fall in Colorado.
Chris Daley, director of the California-based
Transgender Law Center, said Washington's plan to
remove sex-reassignment surgery from its list of
covered services is "pure politics and bad public policy."
"We all understand the impulse to rein in costs, but there's
no cost benefit in denying necessary health care."
While the disorder has been recognized for more
than two decades by the American Psychiatric
Association, few government or private insurance
programs pay for treatment. Washington is one of a few
states where sex-change surgeries have been covered.
The number, however, has been small: six during
the past 15 years.
Medicaid officials said the state has paid for
two sex-change surgeries since 2000, at a total cost
of about $113,000. The issue caused an uproar earlier
After the state auditor revealed the practice,
Republican state legislators tried unsuccessfully to
impose a ban. Republican U.S. senator Charles Grassley
of Iowa wrote Washington governor Chris Gregoire that he
was asking for a federal investigation.
Even before the controversy, however, state
Medicaid officials were working on rules to classify
sex-reassignment surgery as "experimental" and not
eligible for coverage.
A consultant's report commissioned two years ago
concluded there is not enough evidence to show that
surgery is any more effective than hormone treatment
and psychotherapy. "The evidence available to us today is
that [surgery] is not medically necessary," Porter said.
Although the report has been criticized by some
experts, the state began using it as grounds for
denying requests from people seeking coverage for
sex-change surgeries. But the state has lost appeals in both
recent cases. Both involve men seeking to become
women. Both said they suffer from depression and are
backed by medical professionals who say surgery would
be best for them.
The judges noted that the surgery is covered
under current Medicaid regulations. The state has
three more appeals pending. Since all three cases came
after the state adopted new standards based on the
consultant's report, Medicaid officials predict the state
The state has begun rewriting the list of
services covered under Medicaid. Porter said the state
plans to remove surgery as a covered treatment for
gender-identity disorder. (AP)