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HHS Rules Trans Woman Entitled to Surgery Under Medicare

HHS Rules Trans Woman Entitled to Surgery Under Medicare

Charlene Lauderdale

The decision comes just as the Department of Health and Human Services is deciding whether to implement the Affordable Care Act’s endorsement of trans-affirming healthcare for private insurers.

In a landmark decision, the United States Department of Health and Human Services has ruled for the first time that a transgender person is entitled to gender-confirming surgery under Medicare, according to a statement sent to The Advocate by the case's attorney, Ezra Young.

Young represents Charlene Lauderdale, a retired master sergeant in the Air Force, a purple heart recipient, and a trans woman who has waited years to receive the trans-affirming health care from the Veterans Administration through an HMO called United Healthcare/AARP Medicare Complete. The HMO now has the right to bring suit against HHS in federal trial court to contest the decision within 30 days.

"This decision sends a clear message. No transgender person may be denied surgical benefits simply because of outdated ideas regarding transgender health care," says Young in the statement, and he emphasizes that, "genital reconstruction surgery is not experimental, and it is not cosmetic. It is life-saving treatment. Ms. Lauderdale, a decorated combat veteran, has shown true courage while patiently waiting years for the healthcare to which she is entitled as a right. Through her persistence, it is our hope that many others will now be able to obtain the health care they have been so long denied. I am only saddened by those for whom this decision has come too late."

The HHS ruling is particularly affirming for Lauderdale who claimed in a 2014 report from KPRC Houston to have endured pronounced transphobic mistreatment from the VA hospital:

"They called me, 'sir,' or 'fag in a dress.' They told me, 'You don't deserve treatment anyway and I don't want to be bothered by people like yourself,' and I just want to be treated like every other veteran that goes to the VA hospital," Lauderdale told KPRC Houston.

The VA hospital reportedly acknowledged Lauderdale's gender dysphoria and provided her with hormone therapy, but failed to provide full gender-confirming surgery, according to ABC13.

In 2014, HHS lifted the Medicare Ban on gender-confirming surgeries. But, the action two years ago did not mean that health insurers who rely on Medicare were required to provide gender-confirming surgery, and many private health plans still deny trans patients the surgery.

Currently, HHS is deliberating whether to implement section 1557 of the Affordable Care Act, which "would effectively prohibit the same types of transgender exclusions challenged by Lauderdale in almost all private health plans in the nation," says the statement.

"I proudly served our country in the Air Force," says Lauderdale in the statement, "I fought so that our country could remain the beacon of liberty and justice that its ideals call for. Today, this is a victory for the inalienable rights that we as Americans have justice and fairness under our Constitution. I am so relieved that I can now get the medical care that I have needed for so long."

The HHS ruling also marks the most definitive endorsement yet of the World Professional Association for Transgender Health standards of care for medically necessary trans healthcare. The HHS decision closely follows WPATH's standards.

"This welcome decision is a testament to the dedication of those healthcare providers who have persisted in researching and treating transgender and gender-nonconforming people," says Jamison Green, president of WPATH in the statement, "The WPATH standards of care are informed by medical evidence, expert consensus, and the principles of respect and equality, which we at WPATH are grateful to see reflected in this decision."

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