December 11, 2013 | by Chris Johnson
Medicare to examine ban on gender reassignment surgery
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.

Chris Johnson is Chief Political & White House Reporter for the Washington Blade. Johnson attends the daily White House press briefings and is a member of the White House Correspondents' Association. Follow Chris

31 Comments
  • I can only hope that something comes of this…

  • They need to figure it out, the younger ts girls coming up would benefit extremely and that in itself would benefit society, there are lives at stake, this is a big problem in society and it needs to be addressed, keeping my fingers crossed….

  • Veronica Cassidy Boyd

    This would be so great if they did. According to the affordable healthcare act I'm at 150% poverty level even working 40+ hours a week. Srs has only ever really been a distant dream, something I would be saving for the rest of my life only to never achieve.

  • This is much needed. About time the USA enters the 21st century.

  • Actually it seems that the decision to ban this treatment was based on a decision in the mid-60′s by two pharmacist, who regarded SRS as mutilation, the reliability of this data is somewhat questionable.
    One thing for sure, the ban on supporting necessary treatment is based on archaic ideas and the folly of still trying to support this is “mud in the face”. It is discrimination in it’s finest. Let the HHS come up with some other reason, I don’t think so, unless it wants a fervent example made here, discrimination based on gender identity is illegal according to Title VII of the Civil Rights Act of 1964 (Title VII).

    http://www.eeoc.gov/laws/types/sex.cfm

  • I had my srs in 1978. If I did not have this surgery then, I would not be here today. It is beneficial to some who truly are transgendered. I do believe that some of the rules that were in effect back then should be in effect today.

  • I believe we're on the cusp of even better, with the Gatekeeping that was then common, requiring SRS to even have ID that matched the gender one lived and gender no match letters from the federal government to employers (cost people the jobs with which they could pay for surgery, if they even wanted it) already consigned to the dustbin of history.

  • Dreams!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  • I hope they allow HRT and SRS for transgender people. I hear so many people wanting to end their lives due to not appearing as they feel inside or self mutilation.

  • They do cover the HRT although the private drug companies that contract through medicare like to deny coverage. I'm gotten my doctor, counseling, and labs all through medicare. The Part D plan gave me a one time fill as I appeal the decision for them not to pay for the actual drug. http://transequality.org/Resources/MedicareBenefitsAndTransPeople_Aug2011_FINAL.pdf

  • This is very incouraging news! While there are more steps to be completed yet before the review process is completed, it now looks like its only a mater of time before CMS will start covering SRS thru Medicare some time in the not to near future. A rulling by HHS to start allowing Medicare coverage of SRS will make a huge differance in my life and the lives of countless other trans women and men all over this counrty. Since most health insurance providers follow HHS/CMS lead, we can hope that a favorable ruling would also help other insurance provides to also start covering SRS.

  • Danielle Charlotte,

    I am transgendered too as well. I have been in my transition for the past 5 years. I asked my Dr. if he thinks there will be a day that health coverage will start covering SRS.. He told me that Medicare will be reviewing the need for SRS.. and if they should start to allow it then other insurance companies will be follow suit.. I been hoping this day comes as I try to save but in today’s economy it’s virtually almost impossible at times. I hope they begin to cover for SRS and I can get mine done.. I am at a point to where I don’t know when or where or what will happen.. All I know is that I cannot see myself without having it done. I am hoping for a miracle.

  • If you have a good doctor and a good medical coder, then they can code the reasons to use the drugs used for HRT in a way that they will be covered, most of the reasons for any generic drug not being covered can be fixed just in how the need for the drug is coded. The really great part is, they do not have to tell a LIE, because most who are old enough to have part D have medical conditions that hormones are used to treat, it is just not the first drug that comes to mind. Prostrate problems can be treated with Estrogen in Males and Testosterone is used to treat Depression and loss of libido in Women… You can find most of the info you need on US Government websites. The reasons that Hormones are not more widely used for these problems is the “Side Effects” Of course, if you are not concerned that Breast Growth is a “Side Effect” of using Estrogen for Prostrate Enlargement in Males or that Facial Hair growth is a “Side Effect” of using Testosterone to Treat Depression in Females…. The medical proof that they work very well for this is readily available, all you need to do is point this out to your doctor… Once he or she looks at the information most who are willing to treat Gender Issues will also see that they will not be doing anything that would break any law or the Hippocratic Oath… It is just that they need to be willing to think out of the box and ‘Informed Consent” works just as well for protecting the doctor for this “Off Label” use of drugs as the “Informed Consent” for treating Gender Issues…

  • If you want to pay for elective surgery then that is your choice, but you cant expect health coverage paid for by tax payers to pay for this ELECTIVE procedure. I am not trying to be mean or burst bubbles, if you want it pay for it yourself, plain and simple. What next, cosmetic surgery for everyone on free health plans paid for by someone else? Or is that what this is?

  • S Lee Smith thank you heard about this but never knew where to look.

  • This is so stupid.

    Medicare is for old people.

  • well right now I am in a fight with medi-cal which is supposed to pay for the surgery but they are playing their games with me! this is my last attempted at getting it! its been ten years trying. and if I don't this time I know I will be dead its already planed how I will do it!

  • And now lets see the republicans and idiots on FUX News start up again with their BS about providing funding for all of us "Freaks" out here.. I seriously believe the trans community will be a big talking point in the next Presidential election and we all better be prepared to be mocked and made fun of on the national level this time around..

  • And now lets see the republicans and idiots on FUX News start up again with their BS about providing funding for all of us "Freaks" out here.. I seriously believe the trans community will be a big talking point in the next Presidential election and we all better be prepared to be mocked and made fun of on the national level this time around..

  • It is so hard to get up every morning and just try to go into "Ignore mode" when we look into the mirror.. No matter how much makeup and such we put on, no matter what clothes.. I will always feel stuck in the middle and it is so hard to keep the positive attitude about it.. I have had a few friends who could not deal with it anymore and it is so sad to think about how many great people end up dying because we cannot get the surgeries that are so desperately needed.. Life is so cruel sometimes!

  • S Lee Smith I had been on my hormones for about 8 years and insurance was paying for them no issue then I had a CVS pharmacist start giving me the 3rd degree about why am I taking female hormones TN.. He then took it upon himself to call my insurance provider to complain about it, a few days later I got a call from my insurance provider letting me know about his call and that they would no longer cover my HRT and that they had me down in their records as female and that is why they had been covering them previously.. So because of a busy body ass-waffle working at CVS I no longer had coverage for my estrogen and depo.. They still covered my aldactone because it is used for so many other things but was screwed on the others .. :(

  • just get over yourselfs Medicare will not change. Your hormone meds must have caused you to loose brain sells to think they would pay for your cosmetic re construction. you won't get sick if it is not paid for. You won't die if you don't get it paid for. Your not sick so why would you need life saving treatment for a disorder that is all in your head. I think Medicare should pay for your Brain Surgery. Stop bothering the US Government THEY are NOT going to pay for a thing. Get a job and pay for it yourself. Gready Nobodies!!!

  • Kylee Michelle Fraser Janes

    also, remember, the report that was used to justify the ban was written by Cathy Brennan, a KNOWN trans exclusionary radical feminist. her beliefs have long since been discredited (trans women are really just men in dresses) this ban needs to be reexamined on THAT alone

  • Kylee Michelle Fraser Janes

    if you are at 150% poverty level, you'll not qualify for medicare unless you have a disability or are 65 years old. however, at 150% FPL, you qualify for health care subsidies. you will have to buy insurance I'm afraid.

  • Rebecca Ellen Ray

    Danielle Proctor This resonates with a lot of truth & what we see as a deformity can become an overwhelming burden. Some of us can find a way to live as something short of transition but those like me must go all the way. The longer we have to live trapped I between genders the harder it gets to live. Helping with he HRS will save a lot of lives. This has more to do with A Since of self thin sex. The faster this ban is lifted the better it will be.

  • Rebecca Ellen Ray

    Danielle Proctor This resonates with a lot of truth & what we see as a deformity can become an overwhelming burden. Some of us can find a way to live as something short of transition but those like me must go all the way. The longer we have to live trapped I between genders the harder it gets to live. Helping with he HRS will save a lot of lives. This has more to do with A Since of self thin sex. The faster this ban is lifted the better it will be.

  • YES TRUE danielle ı want youre face friend to be

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