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.
State Department
Democracy Forward files FOIA request for State Department bathroom policy records
April 20 memo outlined anti-transgender rule
Democracy Forward on Tuesday filed a Freedom of Information Act request for records on the State Department’s new bathroom policy.
A memo titled “Updates Regarding Biological Sex and Intimate Spaces, Including Restrooms” that the State Department issued on April 20 notes employees can no longer use bathrooms that correspond with their gender identity.
“The administration affirms that there are two sexes — male and female — and that federal facilities should operate on this objective and longstanding basis to ensure consistency, privacy, and safety in shared spaces,” State Department spokesperson Tommy Piggot told the Daily Signal, a conservative news website that first reported on the memo. “In line with President Trump’s executive order this provides clear, uniform guidance to the department by grounding policy in biological sex as determined at birth.”
President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. The sweeping directive also ordered federal government agencies to “effectuate this policy by taking appropriate action to ensure that intimate spaces designated for women, girls, or females (or for men, boys, or males) are designated by sex and not identity.”
Democracy Forward’s FOIA request that the Washington Blade exclusively obtained on Tuesday is specifically seeking a copy of the memo that details the State Department’s new bathroom policy. Democracy Forward has also requested “all” memo-specific communications between the State Department’s Bureau of Global Public Affairs and the Daily Signal from April 1-21.
Federal Government
House Republicans push nationwide ‘Don’t Say Gay’ bill
Measures would restrict federal funding for LGBTQ-affirming schools
Republicans have been gaining ground in reshaping education policy to be less inclusive toward LGBTQ students at the state level, and now they are turning their focus to Capitol Hill.
Some GOP lawmakers are pushing for a nationwide “Don’t Say Gay” bill, doubling down on their commitment to being the party of “traditional family values” by excluding anyone who does not identify with their sex at birth.
The largest anti-LGBTQ education legislation to reach the House chamber is House Bill 2616 — the Parental Rights Over the Education and Care of Their Kids Act, or the PROTECT Kids Act. The PROTECT Kids Act, proposed by U.S. Rep. Tim Walberg (R-Mich.), and co-sponsored by U.S. Reps. Burgess Owens (R-Utah), Mary Miller (R-Ill.), Robert Onder (R-Mo.), and Kevin Kiley (R-Calif.), would require any public elementary and middle schools that receive federal funding to require parental consent to change a child’s gender expression in school.
The bill, which was discussed during Tuesday’s House Rules Committee hearing, would specifically require any schools that get federal money from the Elementary and Secondary Education Act of 1965 — which was created to minimize financial discrepancies in education for low-income students — to get parental approval before identifying any child’s gender identity as anything other than what was provided to the school initially. This includes getting approval before allowing children to use their preferred locker room or bathroom.
It reads that any school receiving this funding “shall obtain parental consent before changing a covered student’s (1) gender markers, pronouns, or preferred name on any school form; or (2) sex-based accommodations, including locker rooms or bathrooms.”
LGBTQ rights advocates have criticized both national and state efforts to require parental permission to use a child’s preferred gender identity, as it raises issues of at-home safety — especially if the home is not LGBTQ-affirming — and could lead to the outing of transgender or gender-curious students.
A follow-up bill, HB 2617, proposed by Owens, one of the bill’s co-sponsors, prevents the use of federal funding to “advance concepts related to gender ideology,” using the definition from President Donald Trump’s 2025 Executive Order 14168, making that an enshrined definition in law of sex rather than just by executive order. There is also a bill making its way through the senate with the same text— Senate Bill 2251.
Advocates have also criticized this follow-up legislation, as it would restrict school staff — including teachers and counselors — from acknowledging trans students’ identities or providing any support. They have said that this kind of isolation can worsen mental health outcomes for LGBTQ youth and allows for education to be politicized rather than being based in reality.
David Stacy, the Human Rights Campaign’s vice president of government affairs, called this legislation out for using LGBTQ children as political pawns in an ideology fight — one that could greatly harm the safety of these children if passed.
“Trans kids are not a political agenda — they are students who deserve safety and affirmation at school like anyone else,” Stacy said in a statement. “Despite the many pressing issues facing our nation, House Republicans continue their bizarre obsession with trans people. H.R. 2616 does not protect children. It targets them. This bill is cruel, and we’re prepared to fight it.”
This is similar to Florida House Bills 1557 and 1069, referred to as the “Don’t Say Gay” bill and “Don’t Say They” bill, respectively, restricting classroom discussions on sexual orientation and gender identity, prohibiting the use of pronouns consistent with one’s gender identity, expanding book banning procedures, and censoring health curriculum.
The American Civil Liberties Union is tracking 233 bills related to restricting student and educator rights in the U.S.
Botswana’s government has repealed a provision of its colonial-era penal code that criminalized consensual same-sex sexual relations.
The country’s High Court in 2019 struck down the provision. The Batswana government in 2022 said it would abide by the ruling after country’s Court of Appeals upheld it.
The government on March 26 announced the repeal of the penal code’s “unnatural offenses” section that specifically referenced any person who “has carnal knowledge of any person against the order of nature” and “permits any other person to have carnal knowledge of him or her against the order of nature.”
Lesbians, Gays and Bisexuals of Botswana, a Batswana advocacy group known by the acronym LEGABIBO, challenged the criminalization law with the support of the Southern Africa Litigation Center. LEGABIBO in a statement it posted to its Facebook on April 25 welcomed the repeal.
“For many, these provisions were not just words on paper — they were lived realities,” said LEGABIBO. “They affected access to healthcare, safety, employment, and the freedom to love and exist openly.”
“LEGABIBO believes that the deletion of these sections is a necessary and long-overdue step toward restoring dignity and aligning our legal framework with constitutional values of equality and human rights,” it added. “It is a clear message that LGBTIQ+ persons are not criminals, and that their lives and relationships deserve protection, not punishment.”
LEGABIBO further stressed that “while this does not erase the harm of the past, it creates space for healing, inclusion, and continued progress toward full equality.”
Democracy Forward files FOIA request for State Department bathroom policy records
House Republicans push nationwide ‘Don’t Say Gay’ bill
Botswana repeals colonial-era sodomy law
LGBTQ people are leaving Orthodox Judaism behind
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Second trans member announces plans to resign from Capital Pride board
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