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Medicare to examine ban on gender reassignment surgery

Rationale for policy ‘not complete and adequate’

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transgender, caduceus, medicare, gay news, Washington Blade, health
transgender, caduceus, medicare, gay news, Washington Blade, health

HHS is set to reconsider the ban on Medicare-provided gender reassignment surgery. (Image public domain)

The Obama administration is set to re-examine the ban that prohibits Medicare from covering gender reassignment surgery, according to a memorandum obtained Tuesday by the Washington Blade.

The document from the Department of Health & Human Services, dated Dec. 2, finds that the reasoning for the ban is “not complete and adequate” to support denying Medicare coverage for transgender people seeking the procedure.

The HHS Department Appeals Board states the ban — which is codified as National Coverage Determination 140.3 — “fails to account for development in the care and treatment” for transgender people over the course of the last 30 years.

The next step, the memo states, is proceeding into a “discovery” phase for the taking of evidence to determine whether the ban can be justified.

Mara Keisling, executive director of the National Center for Transgender Equality, said “there really isn’t that much to say” at this point in the process.

“This is really a preliminary step,” Keisling said. “It’s a good sign, but we have more to go on this.”

Masen Davis, executive director of the Transgender Law Center, was optimistic the ban would be lifted following the discovery process.

“Current Medicare standards are based on science from the 1960s, so it’s about time for a review,” Davis said. “Because the current scientific evidence overwhelmingly shows that sex-reassignment surgeries are effective and medically necessary treatments for some transgender individuals, we are hopeful the board will find the exclusion is not supported.”

The DAB initiated the review of the ban on Medicare-provided gender reassignment surgery in response to a request filed in March by a quartet of LGBT advocates: the National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and civil rights attorney Mary Lou Boelcke.

The challenge was filed on behalf of Denee Mallon, a 73-year-old transgender woman in Albuquerque, N.M. A Medicare recipient, Mallon was recommended to have gender reassignment surgery by doctors to treat her gender dysphoria

In a joint statement provided to the Washington Blade in response to the HHS memorandum, the ACLU, NCLR and GLAD expressed optimism that DAB would come to the conclusion after discovery that the ban on Medicare-provided gender reassignment surgery should be lifted.

“Because the current evidence overwhelmingly shows that sex-reassignment surgeries are effective and medically necessary treatments for some individuals with gender dysphoria, we are hopeful the Board will find the exclusion is not supported,” the statement says.

According to the memorandum, the ban was put in place in 1989 as a result of a 1981 report from the National Center for Health Care Technology, an arm of HHS. The report concluded “transsexual surgery not be covered by Medicare at this time” because of the high rate of complications and questions about whether it was effective in treating gender identity disorder.

“Transsexual surgery for sex reassignment of transsexuals is controversial,” the regulation states. “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.”

Despite the institution of this policy, the American Medical Association and the American Psychological Association support gender reassignment surgery for transgender people as a means to treat gender identity disorder.

Notably, the Centers for Medicare & Medicaid didn’t put up a fight in response to the request from LGBT advocates to lift the ban. According to the memo, CMS notified the board in June that it wouldn’t submit a response to their request to lift the ban.

Neither HHS nor CMS responded to the Blade’s request for comment on the determination or why it declined to defend the ban.

It’s unclear when the discovery period for reevaluating the ban on Medicare-provided gender reassignment surgery will come to an end. Shawn Jain, a spokesperson f0r the ACLU, said his organization doesn’t know when the process will be complete.

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Pentagon

Supreme Court ruled Boy Scouts could exclude James Dale. Now he says that same rule protects LGBTQ scouts from Trump

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Scouts marching in a Pride Parade. (Washington Blade file photo by Michael Key)

James Dale spent a decade fighting the Boy Scouts of America after the organization expelled him for being gay. The Supreme Court ultimately ruled that the Scouts had a First Amendment right to exclude him.

Now, Dale is invoking that same constitutional principle in a new fight over the organization he once sued — arguing that the federal government cannot use its relationship with Scouting America to pressure the private organization into abandoning policies protecting LGBTQ people and other marginalized Scouts.

“I find myself in this interesting, ironic place where I’m defending the decision that expelled me,” Dale told The Washington Blade. “That said, Scouts, you have a First Amendment shield to protect yourselves from the DOD.”

Dale’s latest legal push began with a question about what exactly the Pentagon and Scouting America had agreed to.

In recent years, Scouting America has made significant progress toward becoming a more inclusive organization — from removing its bans on LGBTQ scouts and leaders, to providing opportunities for women and girls to participate in Scouting, to making Scouts of color feel more supported and visible within the organization.

Those changes angered Defense Secretary Pete Hegseth, who has never been a Scout, to the point that he threatened to sever the military’s longstanding ties with the organization.

Such a move would mean that the U.S. military would no longer provide medical and logistical support for the National Jamboree, the massive gathering of Scouts in West Virginia that typically draws about 20,000 participants. It would also prevent Scout troops from meeting on U.S. or overseas military installations, where many bases host active Scouting programs.

In February, before his threat was carried out, Hegseth announced that the Pentagon had reached an agreement with Scouting America that he said would refocus the organization away from diversity initiatives and other policies he characterized as “woke.” He again threatened to end the military’s longstanding support for the organization if it failed to comply within six months.

Hegseth also placed particular emphasis on Scouting America’s policies regarding transgender youth, saying the organization would require members to use their “biological sex at birth and not gender identity.”

But Scouting America President and CEO Roger Krone struck a different tone.

“We have transgender people in our program and we’ll have transgender people in our program going forward,” Krone told The Associated Press in February.

The conflicting messages prompted Dale to dig deeper.

He filed a Freedom of Information Act request seeking the memorandum between the Pentagon and Scouting America. When the Defense Department did not provide the document, Dale turned to attorney Isaac Park, a former Supreme Court clerk, and sued the department for its release.

“I wanted to get to the bottom of what deal had been struck with Scouting America under pressure,” Dale said. “What pressure did the Pentagon apply on a private youth organization that had a right to determine their own members?”

Park, who also spoke to the Blade, said they deliberately took a narrow approach to the FOIA lawsuit, seeking a single document rather than launching a broader fight over thousands of pages of government records.

“We had one document that we really wanted, which was this memorandum, and we were going to ensure that there’s like a lead-pipe, stone-cold case for disclosure,” Park said.

The strategy worked quickly.Three weeks after the lawsuit was filed, the Pentagon released the memorandum.

But the document did not end Dale and Park’s questions. Instead, they said, it raised new ones.

Hegseth had publicly described a six-month window for Scouting America to make changes. But the memorandum provides for an ongoing compliance mechanism, with reviews taking place every 90 days.

For Dale and Park, that raises the possibility that the Pentagon could continue pressing Scouting America to change its policies long after the February agreement was announced.

Park describes their concern as “jawboning” — government pressure on a private organization to achieve a desired policy outcome without directly ordering the organization to make a change.

“We saw in the weeks after the announcement of the memorandum changes being made to Scouting America’s policies,” Park said. “Them saying one thing, the department saying a slightly different thing, and our first question then was, of course, like, what is actually in this memorandum? Is this how they kind of got what they wanted?”

The memorandum, Park said, clarified some questions but did not account for other changes Scouting America made.

“That naturally arises: Well then, how did those changes come about?” he said.

Dale points to changes at Scouting America’s National Jamboree as an example of what he believes could be the result of the pressure.

The organization removed dedicated spaces for girls, Scouts of color and LGBTQ Scouts at the flagship event, which concluded last week.

“We see spaces for girls being eradicated, spaces for kids of color, spaces for gay people, for trans kids,” Dale said. “It happened at the flagship event of scouting, the jamboree.”

Dale said he fears similar changes could occur at the local level, including at Scout meetings and council events.

“All this document is empowering the government to keep pressing, keep putting pressure on Scouting America,” Dale said. “And what is that doing to American kids?”

The dispute is particularly striking because of Dale’s own history with the organization.

Dale had a long history with Scouting before the organization expelled him in 1990. At the time, he was a 19-year-old student at Rutgers University in New Jersey and was serving as an assistant Scoutmaster for Troop 73.

While attending Rutgers, Dale became co-president of the university’s Lesbian/Gay Student Alliance and was interviewed by The Star-Ledger about the health and well-being of LGBTQ students.

The interview made its way to Boy Scouts officials. The organization subsequently expelled Dale after learning that he was gay, describing him as an “active sodomite.”

Dale sued the Boy Scouts under New Jersey’s public accommodations law and initially won. The New Jersey Supreme Court ruled in his favor, finding that the state’s interest in preventing discrimination outweighed the organization’s claimed right to exclude him.

The Boy Scouts appealed to the U.S. Supreme Court.

In a 5-4 decision in 2000, the Supreme Court reversed the New Jersey ruling, holding that forcing the Boy Scouts to accept Dale as an openly gay assistant scoutmaster would violate the organization’s First Amendment right to freedom of expressive association.

The Scouts had argued that homosexual conduct was inconsistent with the values it sought to instill in young people.

Dale was devastated by the ruling.

“I thought it was the wrong decision at the time,” he said.

But the constitutional protection the Supreme Court recognized in his case is now at the center of Dale’s argument against the Pentagon.

The Boy Scouts’ policies have changed dramatically since Dale’s case. The organization began allowing openly gay youth in 2013 and gay adult leaders in 2015. It later expanded its policies to include transgender youth and adults.

The Boy Scouts of America formally changed its name to Scouting America in 2025.

Dale said those changes were made voluntarily — precisely the kind of private organizational decision that the Supreme Court’s ruling in his case protected.

“They did it voluntarily,” Dale said. “They won the Supreme Court case against me.”

Now, he argues, Scouting America should invoke that same protection against the government.

Park said that is the central constitutional question behind their efforts.

“In 1990, when he was expelled from the Scouts for being gay, and in 2000, after a narrow 5-4 loss at the court, we were told that a private entity, an organization like Scouting, are allowed to set their own membership policies,” Park said.

Over the following two decades, Park said, Scouting America changed those policies on its own.

“We won the culture war,” Park said. “Organizations like Scouting America decided on their own, of their own free will, that actually what they want is to be inclusive with respect to gay youth, with respect to trans youth.”

The question now, Park said, is whether the government can pressure an organization to reverse those voluntary decisions.

“I think that the story here is that of jawboning,” Park said. “Our question has always been the how of how this administration is achieving whatever policy goals, whatever ideological outcomes that they want.”

Dale sees the issue as extending well beyond Scouting America.

“It’s not even about the scouting program,” Dale said. “It is, but it’s much bigger than that. It’s about really what the executive branch is doing to private organizations that have a right to set their own policies for membership.”

Park said the argument could appeal to people across the political spectrum.

“During the Biden administration, it was COVID policy, and it was the NRA that the right was screaming about jawboning,” Park said. “This is a bipartisan issue in the sense that no one thinks the government is allowed to do this.”

For now, Dale and Park are seeking more information.

Park said their review of the memorandum left them with additional questions about the Pentagon’s relationship with Scouting America and whether the 90-day compliance mechanism is being used to continue influencing the organization.

“Disclosure or transparency is the right remedy for this,” Park said.

Dale’s interest in Scouting is not merely legal.

He said he still believes deeply in the organization and had returned to involvement with Scouting only recently, after years away.

“I love scouting,” Dale said. “I fought for a decade to get back in scouting.”

That makes his current position all the more unusual.

The organization that once fought him in court is now the organization he is trying to defend from government interference.

“I never thought that would be the case,” Dale said. “That would be saving queer kids.”

Dale said he hopes Scouting America will ultimately stand up for the policies it adopted after his Supreme Court case.

“They didn’t want gay people in the ’90s. Fine, I thought that was wrong,” Dale said. “But now they want to have trans kids. They want to have girls. They want to have kids of color.”

“But Donald Trump and Pete Hegseth don’t want them to,” he said.

The Pentagon declined to comment on Dale’s allegations or the ongoing litigation.

“As a matter of policy, we do not comment on ongoing litigation,” a Pentagon spokesperson told The Washington Blade via email.

The Blade also contacted Scouting America seeking clarification about its agreement with the Pentagon, including whether Hegseth or other Defense Department officials had pressured the organization to remove or alter policies protecting LGBTQ Scouts, girls, or Scouts of color.

Scouting America did not respond to a request for comment.

For Dale, the fight has brought his long-running legal battle with the Scouts full circle.

He spent the 1990s arguing that the organization should not be permitted to exclude him because he was gay. The Supreme Court ultimately said the Scouts had a constitutional right to make that choice.

Now Dale is arguing that the government cannot force the organization to make a different choice.

“I realized over the course of my life that I expected the institution to save me,” Dale said. “I expected the Boy Scouts of America to do the right thing. I expected the legal system, the Supreme Court, to do the right thing.”

“Neither one did,” he said. “You got to fight for yourselves.”

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Minnesota

Flanagan beats Craig in Minn. Senate primary after winning key LGBTQ endorsements

The race highlights a growing ideological shift within the Democratic Party, as Democrats increasingly seek a more robust pushback against Trump.

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Lt. Gov. Peggy Flanagan (D-Minn.) will run as the Democratic nominee for Minnesota. (Photo public domain)

Lt. Gov. Peggy Flanagan won the Democratic primary for the Senate in Minnesota, as progressive Democrats continue to clinch nominations across the country.

On Tuesday night, NBC News called the race for Flanagan, who received 59.0% of the state’s Democratic primary vote, while her opponent, Rep. Angie Craig, received 39.4%. Flanagan ran against Craig for retiring Sen. Tina Smith’s seat. 

Smith, along with Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass., endorsed Flanagan, while House Minority Leader Hakeem Jeffries, D-N.Y., and former House Speaker Nancy Pelosi, D-Calif., backed Craig.

Flanagan also received the endorsement of the Christopher Street Project, a transgender rights organization that has been at the center of efforts to counter the Republican Party’s push against transgender rights. The group chose Flanagan over Craig in part because Craig has not co-sponsored the Trans Bill of Rights, legislation that has been introduced multiple times in Congress and seeks to establish federal protections for transgender Americans.

The endorsement underscored a key difference between the two Democrats on LGBTQ issues. While Craig is the first openly lesbian mother in Congress, the Christopher Street Project said LGBTQ identity alone is not enough without a strong commitment to transgender rights as they are increasingly debated in legislative offices around the country.

In 2022, the Human Rights Campaign, the largest LGBTQ advocacy organization in the U.S., endorsed Flanagan’s re-election campaign for lieutenant governor alongside Tim Walz, calling the duo “Champions of Equality.”

Flanagan called the race an expensive fight of the “many versus the money,” Flanagan told NBC News’ “Meet the Press Now.” Craig and her allies combined to spend nearly $20 million on the airwaves, while Flanagan and her allies spent $4.7 million, according to AdImpact and NBC.

“I’m running to make sure that people can afford the lives they want to live,” Flanagan said. “I want to get big money out of our politics, and I want to fight for things like ‘Medicare for All’ so that people aren’t just paying for health insurance but actually have access to health care.”

Flanagan criticized Craig, who is in her fourth term, for not standing up enough to President Donald Trump’s administration, a characterization Craig disputed. Craig flipped a competitive House seat in the Twin Cities metro area and had argued that she was the best candidate to win in November.

Craig faced criticism for voting for the Laken Riley Act, an immigration detention measure that Trump signed into law shortly after he started his second term in January 2025. Craig said she later regretted that vote.

Flanagan has been vocal about her stance on abolishing U.S. Immigration and Customs Enforcement. In a recent Minnesota Public Radio debate she said that ICE “has to be ripped apart.” Flanagan said she does support immigration enforcement to ensure secure borders.

Immigration and ICE debates are especially pertinent in the Twin Cities, as ICE agents fatally shot two U.S. citizens, Renee Good and Alex Pretti, in Minneapolis during an enforcement crackdown at the behest of President Trump.

Despite the contested race, Craig made it clear that Democrats are committed to unifying.

“We have an existential crisis in our nation with Trump and Republicans, and so I would be right by the lieutenant governor’s side asking my supporters to support her,” Craig said. “The most important thing in this election is that we beat Republicans. That’s what matters.”

On the Republican side, former NFL sideline reporter Michele Tafoya won the Senate primary. Considered an outsider to the Republican Party structure, she did not win the state GOP’s endorsement at the May convention, where delegates instead backed retired Navy SEAL Adam Schwarze.

She has run her campaign on a slew of issues Republicans have deemed worthy — including transgender sports participation, corruption, and minimizing illegal immigrants in the area.

This recent pattern of moderate and centrist Democrats raising huge funds — in many instances backed by major PACs — only to lose to more progressive and less experienced candidates is growing as more people grow disillusioned with the Democratic Party’s inability to push back against Trump and Republicans. A similar outcome happened in Michigan’s Democratic primary last week when progressive physician Abdul El-Sayed won over incumbent U.S. Rep. Haley Stevens (D-Mich.).

Democratic Gov. Tim Walz, who decided not to run for re-election, stayed neutral in the Senate primary but his wife, Gwen, backed Craig over Flanagan, the governor’s ticketmate.

The Senate seat will be determined in the election on Tuesday, November 3, later this year.

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District of Columbia

Gay ANC commissioner sues D.C. over police ‘failure’ to pay reward money

Lawsuit says information led to conviction in murder, armed robbery cases

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D.C. Advisory Neighborhood Commissioner Tom Donohue (Washington Blade photo by Lou Chibbaro, Jr.)

Gay D.C. Advisory Neighborhood Commissioner Tom Donohue on Aug. 11 filed a lawsuit in D.C. Superior Court charging that D.C. police acted improperly and violated a local law by not paying him $30,000 in reward money for his role in helping police identify and arrest — and obtain the subsequent conviction — of one man charged with murder and another man charged with armed robbery in separate cases.

Although the lawsuit alleges improper action by D.C. police in carrying out the city’s Crime Solvers reward program, it names as defendants the District of Columbia and the Office of the Attorney General for D.C., which, among other things, defends the city against lawsuits.

Donohue, who is a member of the city’s ANC Rainbow Caucus consisting of LGBTQ elected ANC members, held a news conference outside the D.C. Superior Court building on Aug. 11 to talk about the lawsuit before entering the courthouse to officially file it.

The lawsuit states that Donohue “provided key video evidence that led to the arrest and conviction” of a man initially charged with first degree murder for allegedly running over a bicyclist with his car after the two got into an argument.

The lawsuit states that police had offered a $25,000 reward for information leading to the arrest and conviction of the defendant in that case, but police “arbitrarily slashed the payment to $5,000 without prior notice or policy justification.”

Court records show that D.C. resident Eric Beasley was charged with first degree murder for killing David Farewell, 45, by hitting him with his car on Sept. 4, 2020, on the 2100 block of Young Street, S.E. The records show the evidence for the case was based in large part on video camera footage of the incident obtained by police. Donohoe has said he provided that video camera evidence.

The records show that during Beasley’s October 2023 trial a jury was unable to reach the required unanimous verdict, and the judge declared a mistrial.

According to the records, Beasley later agreed to an offer by prosecutors to plead guilty to a lesser charge of involuntary manslaughter and was sentenced in September 2024 to eight years in prison, a development that angered the victim’s family members who called it a “slap on the wrist,” according to a Fox 5 News report.

Donohue’s lawsuit says the second case in which he provided police with pivotal information involved a series of armed robberies known as the Fairlawn Serial Armed Robbery Spree that occurred in the Fairlawn neighborhood in Southeast D.C. in 2023 near where Donohue lives.   

The lawsuit says evidence consisting of video surveillance footage provided by Donohue to police enabled police to determine they initially wrongfully arrested an 18-year-old male for the robberies. “Using Plaintiff’s security video, MPD identified, arrested, and convicted the actual robber, David Crocker, who was sentenced to 18 years in federal prison,” the lawsuit states.

It says one of the detectives investigating the case recommended a $10,000 reward for Donohue’s help in the case based on the police Crime Solvers reward program. The detective’s recommendation was approved by then-Assistant D.C. Police Chief Kyle Ramey on Aug. 4, 2025, according to the lawsuit. 

But it adds, “Nevertheless, MPD improperly withheld payment.” 

When contacted by the Washington Blade for comment on Donohue’s lawsuit allegations, a D.C. police spokesperson said “MPD does not comment on pending or ongoing litigation.” 

Gabriel Shoglow-Rubenstein, who serves as press secretary for the D.C. Office of the Attorney General, which will be defending the city against the Donohue lawsuit, said he would look into obtaining a possible comment but said the office has a similar longstanding policy of not commenting on pending litigation.

“This action arises from the District of Columbia Metropolitan Police Department’s arbitrary, bad-faith, and legally unsupportable failure to honor its public reward promises and administrative obligations to Plaintiff,” the lawsuit states.

It says the MPD violated the city’s Freedom of Information Act or FOIA law by not responding to Donohue’s request for information and documents related to the decision not to pay him the full reward money.

“MPD’s reduction of Plaintiff’s homicide reward from $25,000 to $5,000, and its withholding of his approved $10,00 robbery reward, were undertaken completely devoid of written standards, making such decisions inherently arbitrary, capricious, and an abuse of administrative discretion,” it says.

It calls for Donohue to be awarded $30,000 in compensatory damages consisting of the $20,000 “unpaid balance” for the homicide case reward and $10,000 for the robbery case reward. It also calls for reimbursement for “reasonable” litigation costs and attorney’s fees. Donohue told the Washington Blade that at this time he is representing himself without an attorney.

Donohue told the Blade that the refusal by D.C. police to pay him the full reward money also limited his plans to donate some of that money to the family of murder victim David Farewell to help pay for a burial stone. He said that due to the family’s limited resources Farewell is buried in an unmarked grave

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