News
Medicare to examine ban on gender reassignment surgery
Rationale for policy ‘not complete and adequate’

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.
Maryland
Anne Arundel schools updates gender identity regulation following Trump administration threats
District facing federal lawsuit, White House threats over guidelines
By JESSICA CALEFATI | Under pressure from the Trump-Vance administration, Anne Arundel County Public Schools Supt. Mark Bedell announced Wednesday the district had updated a regulation intended to protect transgender students’ right to be called by their chosen name.
The revised language makes clear that district rules on gender identity do not block parents’ rights under the Family Educational Rights and Privacy Act as the federal government alleged last month, and that a student’s gender identity will not be treated as confidential medical information.
“No policy, guideline, or practice may limit or otherwise interfere with parental rights under FERPA,” Bedell wrote in a Wednesday letter to the community. “This includes any information maintained in education records that relates to gender identity, transgender status, sexual orientation, preferred name, or preferred pronouns.”
The rest of this article can be read on the Baltimore Banner’s website.
Netherlands
Thailand’s first openly gay senator attends World Pride in Amsterdam
Blade sat down with Pornchai Witayalerdpan on Aug. 7
Editor’s note: International News Editor Michael K. Lavers and Photo Editor Michael Key were on assignment in the Netherlands from July 28-Aug. 10.
AMSTERDAM — The first openly gay man elected to the Thai Senate says the law that extended marriage rights to same-sex couples in Thailand has positively impacted his country’s global image.
“It totally changed how the world perceived Thailand,” Sen. Pornchai Witayalerdpan told the Washington Blade on Aug. 7 during an interview at the World Pride Human Rights Conference in Amsterdam.
Thailand on Jan. 23, 2025, became the first country in Southeast Asia to allow same-sex couples to legally marry.
The marriage equality bill received final legislative approval in June 2024 when the Senate approved it by a 152-130 vote margin. King Maha Vajiralongkorn signed it a few months later. Then-Prime Minister Prime Minister Paetongtarn Shinawatra is among those who supported the law.
Witayalerdpan was a freelance interpreter before he took office in July 2024.
The independent senator noted Thailand’s marriage equality movement began to gain traction with a lawsuit that the Foundation for Sexual Orientation and Gender Identity Rights and Justice, a Thai advocacy group, filed.
The Constitutional Court in 2021 upheld a law that defined marriage as between a man and a woman. MP Tunyawaj Kamolwongwat of the Move Forward Party later introduced the marriage equality bill that became law.
“It was a coalition of efforts between the civil society organizations, the LGBTQ organizations, and also the Pride movement in Thailand,” Witayalerdpan told the Blade.
Taiwan in 2019 became the first country in Asia to extend marriage rights to same-sex couples.
The Nepalese Supreme Court in June issued a landmark ruling that ordered the country’s government to guarantee full marriage rights to same-sex couples.
The Japanese Supreme Court in March said it will consider six marriage equality lawsuits that have been filed in the country. The Indian Supreme Court in 2023 ruled against marriage rights for same-sex couples. South Korea is among the other Asian countries in which marriage equality efforts are gaining momentum.
Witayalerdpan said Thailand’s marriage equality law could have a direct impact in Japan, which is the only G7 country that does not legally recognize same-sex couples.
“It’s been nothing but a positive effect (in Thailand) after the same-sex marriage law (took effect),” he said.

InterPride, the organization that coordinates World Pride events, has announced Bangkok and Barcelona, Spain, are the two finalists to host the biennial event in 2030. (World Pride took place in D.C. in 2025.)
Witayalerdpan told the Blade that World Pride in Bangkok would further improve Thailand’s global image. He also said his fellow lawmakers, in turn, should pass LGBTQ rights bills — including proposals that would allow transgender people to legally change their name and gender and enable same-sex couples to have children via surrogates from in vitro fertilization. Witayalerdpan noted the most important bill to him is one that would strengthen Thailand’s LGBTQ-inclusive nondiscrimination law that took effect in 2015.
Impact of US funding cuts has ‘been very hard’
Witayalerdpan also offered advice to activists in the U.S. and elsewhere around the world.
“Keep on pushing forward,” he told the Blade. “I know that it’s hard for activists in Thailand as well.”
Witayalerdpan acknowledged the loss of U.S. government funding since the Trump-Vance administration took office — which has forced advocacy groups in Asia and elsewhere around the world to close — has “been very hard.” Witayalerdpan noted the global LGBTQ and intersex rights movement in response to these cuts has turned to the European Union, the U.K., Canada, and the Netherlands to help fill the gap.
“It’s very good that these countries are providing more funds to the activists in Asia than before because of the Trump situation,” he told the Blade. “It can increase their soft power as well.”
Witayalerdpan said American activists should “wish for a positive result in the mid-term elections.”
“Then there is some resistance,” he added.
Witayalerdpan specifically highlighted efforts to fight against the Trump-Vance administration’s efforts to restrict gender-affirming healthcare.
A federal court in Massachusetts on Aug. 15 struck down a key provision of a U.S. Department of Health and Human Service rule that would have limited access to gender-affirming care under the Affordable Care Act. Maryland and California are two of the 21 states that sued the Trump-Vance administration over the issue.
“You have to show more resistance … to show that we are still here and we will push back when we can,” said Witayalerdpan.
Pennsylvania
Philadelphia gayborhood preservation battle raises questions about displacement
Opponents of historic designations worry about new burdens on property owners
Philadelphia’s Washington Square West neighborhood — which is home to the city’s Gayborhood — was awarded a historic designation in 2024. While many LGBTQ+ Philadelphians were excited by news of preserving approximately 1,500 residences, religious spaces and business properties spanning the 26 included blocks, the designation was not celebrated by all.
Advocates, including the Washington Square West Civic Association and various LGBTQ+ residents, partly framed the designation as long-overdue recognition for the area’s LGBTQ+ culture and Black history — but opponents argued it would impose costly restrictions on property owners and limit new development. A group of property owners — which also includes LGBTQ+ people — took the city to court over the designation and successfully overturned the decision.
The judge cited a lack of substantial evidence as a leading cause for his decision despite the Philadelphia Historic Commission’s nearly 1,500-page nomination packet. Attorney Dan Auerbach, representing the residents who opposed the designation, told WHYY that the documents submitted didn’t explain why many of the properties hold historic significance. Just 173 properties were described as historically significant, he argued. However, 773 of 1,509 properties included in the boundary — more than half of the neighborhood’s properties — are already listed in the National Register of Historic Places.
In March, the judge’s ruling was vacated after an appeal — effectively forcing the process to start over. The historic designation stands in the meantime. The Preservation Alliance for Greater Philadelphia is now drafting its own brief — due May 18 — to support the city’s position, which the organization’s executive director Paul Steinke believes will elaborate on the merit of the designation as a supplement to the city’s arguments.
Scholars have found that Philadelphia’s local historic designation offers a more protective effect on buildings facing possible demolition than the national register. Because zoning and construction is overseen by local laws and leaders, local designations play a stronger role in preservation. But that doesn’t mean buildings with the designation are guaranteed to be preserved.
The outcome of this lawsuit could affect a major re-development project that would benefit the LGBTQ+ community but has been met with mixed feelings. William Way LGBT Community Center (WWCC), which is currently housed in a pre-Civil War era building that would be harder to demolish under the designation, is set to be leveled (along with a famous LGBTQ+ mural on its facade) to build a more accessible space for gatherings and queer-centered low-income housing units.
Steinke underlined that it’s possible for the project to move forward as-is. Historic designations do not prevent every demolition. There are standards in place that allow for demolition, which WWCC would need to meet for the project to be approved.
WWCC leaders would need to appear before the historical commission to seek a demolition permit before applying to the city, but that obstacle would be removed if the historic designation is overturned.
Historic designation is mostly used to preserve the character of buildings through recommendations about how owners can restore or maintain exterior facades. Steinke hopes WWCC will adjust its plans to maintain all or some of the most important historic elements of its current home (the facade, historic marble and wooden staircases, entryways and ballroom) rather than demolishing it all outright. He hasn’t lost hope, but he admits he hasn’t convinced anyone at WWCC to change the current plans.
It’s a project that seems to place competing interests in tension. There’s a need for housing — especially income-specific, LGBTQ+ centered projects — in that neighborhood. This, as Steinke hopes, could be pursued without demolishing much-loved cultural landmarks — but WWCC has emphasized that the price tag for pursuing its goals this way makes preservation out of reach.
The Washington Square West litigation is one of three active lawsuits pending against historic districts in Philadelphia. Six newer proposals are also currently in various stages of the nomination process — but if approved, they too could be contested and overturned.
A 2002 attempt to designate Spruce Hill was unsuccessful due to resident opposition that may have been fueled by politics. It was the third attempt to nominate the neighborhood. A case study published in 2023 by a University of Pennsylvania student about the matter found that the opponents feared increased maintenance costs, the loss of personal freedom and gentrification.
“Ironically, in the two decades since that campaign, Spruce Hill has become one of the most gentrified — and threatened — neighborhoods in the city of Philadelphia,” the study notes.
Residents also feared displacement. The case study underlines that residents who are displaced by gentrification tend to move to neighborhoods with lower property values, less access to resources, and fewer opportunities for upward economic mobility.
Following historic designation, the number of college-educated households in a community tends to increase while the poverty rate drops in contrast to its adjacent neighborhoods, which do not receive the designation. These and other factors contributing to economic mobility are visible on maps created by the Opportunity Atlas, a project of Harvard University which presents information collected by the census in an effort to tangibly discuss economic mobility in localities across the United States. It shows the same patterns in many of Philadelphia’s historic districts.
But the Washington Square West neighborhood outperformed the surrounding blocks even before the historic designation took effect — highlighting that the designations themselves may not always be the cause of disparities.
“It’s true that in most cases, historic districts aren’t the most affordable neighborhoods in any city — no matter where you go,” Steinke said. “That’s not the fault of the historic district.”
Historic districts tend to protect properties and neighborhoods that are historically, architecturally, or culturally significant — properties that already tend to be expensive.
For example, Steinke underlined that Rittenhouse Square was expensive before it was officially designated as historic — and some neighborhoods, like Graduate Hospital, have become pricey without the designation.
Historic preservation may actually promote some protective factors that act as a buffer against gentrification and rising rents, contradicting the most common fears. For instance, the designation makes it harder for developers to tear down smaller, older, more affordable homes or significant community hubs that sit on desirable land in order to build newer, larger, high-cost housing units in their place.
Many LGBTQ+ locals opposed the redevelopment of the Gayborhood’s former 12th Street Gym — which held cultural significance and a meaningful mural of queer activist Gloria Casarez. It was removed alongside a neighboring building of note for its connection to Black history. A luxury high-rise apartment complex now takes its place.
Residents of a working-class neighborhood in Durham, N.C. hoped they would stave off developers and prevent or slow gentrification by pursuing historic designation in 2016.
Steinke explained that this has happened in Philadelphia too.
The Parkside neighborhood, which is situated near the Please Touch Museum, has been a historic district for 15 years, Steinke explained. It was a low to moderate income, majority minority neighborhood when it was designated in 2009 and it still is today, he said. The same is true for West Diamond Street in North Philly, which was designated historic in the 1980s. It was a low to moderate income neighborhood then and has remained one today.
“Real estate prices are a factor of so many other things — proximity to work, public safety, access to schools, access to shopping and other amenities, transportation,” Steinke said. “That’s really what determines property values and neighborhood value.”
Those are also factors that have strong correlations with upward economic mobility.
Despite a poverty rate that is lower than it has been in decades, Opportunity Insights ranks Philadelphia as last among large metro areas for upward economic mobility — with some children experiencing even worse economic outcomes than their parents. It’s a problem Mayor Cherelle Parker has addressed with new initiatives she hopes will support young people who hope to break free from cycles of poverty.
The supplemental programs that offer economic support to historic homeowners in Durham might have helped its anti-gentrification efforts succeed.
Steinke said it’s true that some preservation-oriented maintenance costs may be higher upfront, but many of those options also last longer and could even cost less than cheaper fixes that must be repeated over time.
“One real weakness in Philadelphia is that there is no publicly available funding to help homeowners maintain their historic homes, and that’s something that we have talked about with city officials, with city council, with the mayor’s office,” he added. “There really needs to be a fund that homeowners can apply to if their property is designated historic — especially for low to moderate income homeowners.”
Although there isn’t a city fund or initiative to help offset maintenance costs for historic homeowners in Philadelphia, a few state and federal tax incentives could be helpful to some historically-designated property owners — including landlords and developers who might not otherwise pursue preservation.
“Not many property owners or homeowners have a lot of expertise about what’s best for a historic building to maintain its value and its appearance,” Steinke said. “So when historic districts are in place, you actually have access to experts who know the best practices and can share them with you and help you find solutions to the problems you’re trying to solve.”
The Preservation Alliance for Greater Philadelphia collaborated with the Washington Square West Civic Association to publish a manual that will be released in late spring or early summer. It will provide information about historic practices for windows, doorways, carpentry, masonry and roofs pertaining to the area’s buildings.
There’s been an increase in low-income households in Philadelphia’s historic districts and top earners are moving in at a slower rate than in neighborhoods in the rest of the city.
Racial diversity is shifting in there, too. Although these districts tend to have whiter populations, a report published by the Preservation Alliance shows that non-white homeownership in Philly’s historic districts has increased significantly since 2010. The number of non-white homeowners and Black and Hispanic residents is on the rise in these districts, even as diversity has slowed in other neighborhoods.
“We think [this report] shows that historic designation is not an obstacle to housing production or population growth,” Steinke said.
Steinke argues that the buildings in Washington Square West have economic value not only to those who own or utilize the buildings but to the city as a whole. They’re an economic engine — creating jobs and drawing tourists. Almost 6% of Philadelphia’s jobs are in historic districts, including nearly 10% of small business jobs, 13% of new jobs, and almost 17% of creative jobs.
The 250th anniversary of the United States will bring visitors hoping to immerse themselves in Philadelphia’s history. Visit Philly estimates the events could contribute up to $2.5 billion to the city’s economy.
Some funding is making its way to historic districts in preparation for the events by way of grants for programming and beautification projects. But that doesn’t make them an accessible place to do business.
Historic districts aren’t necessarily start-up friendly. Commercial rent tends to be higher there too — a frequent complaint among LGBTQ+ business owners who want to open brick-and-mortar locations in the Gayborhood but are priced out.
(This article was originally published by the Philadelphia Gay News and is part of a national initiative exploring how geography, policy, and local conditions influence access to opportunity. Find more stories at economicopportunitylab.com.)
