June 13, 2014 | by Chris Johnson
Ban lifted on trans-related health care for fed’l employees
trans, transgender flag, gay news, Washington Blade

OPM will allow coverage of transition-related care for federal employees (Washington Blade file photo by Michael Key).

The Obama administration announced quietly on Friday it would lift the ban prohibiting health insurance carriers from covering transition-related care for transgender federal employees.

In a memo dated June 13, the U.S. Office of Personnel Management informs Federal Employee Health Benefits carriers that it would no prevent coverage of transgender-related care beginning with the 2015 plan year. The news was first reported by Buzzfeed.

“There is an evolving professional consensus that treatment is considered medically necessary for certain individuals who meet established Diagnostic and Statistical Manual (DSM) criteria for a diagnosis of Gender Identity Disorder/Gender Dysphoria,” writes Healthcare and Insurance Director John O’Brien.

The memo states OPM is “removing the requirement that FEHB brochures exclude ‘services, drugs, or supplies related to sex transformations’ in Section 6 of the FEHB plan brochure effective with the 2015 plan year.” These services include gender reassignment surgery for transgender federal employees, according to the National Center for Transgender Equality.

Mara Keisling, executive director for the National Center for Transgender Equality, commended OPM for “modernizing their policy” to provide coverage for transgender employees.

“There are a lot of trans federal employees who have their jobs protected, but who are getting discriminatory health care,” Keisling said. “I think OPM realized that. That’s equalizing that, and this is really great and important.”

But the change in policy doesn’t require carriers to provide transgender-related health care. Carriers are given one of two options by June 30, 2014: 1) Remove the General Exclusion language and provide to OPM the specific brochure text that describes the covered components and limitations of care for the diagnosis; or 2) Maintain the General Exclusion language for the 2015 plan year.

LGBT advocates had been pushing — publicly and privately — for the change for some time, saying it was one of the last remaining anti-LGBT discriminatory policies made by the U.S. government.

David Stacy, director of government affairs for the Human Rights Campaign, was among those hailing the change in policy from the Obama administration.

“Today’s welcome decision by the Office of Personnel Management to remove this discriminatory and harmful exclusion is an important step towards closing the gap in access to quality health care for transgender workers,” Stacy said. “HRC urges FEHB insurance carriers to include this essential coverage in their plans so that federal workers have access to medically necessary transition-related care.”

Although OPM says coverage is optional for carriers, Keisling said her organization believes they would be in violation of the law if they refused to offer transition-related care to transgender people.

“We think they’ll be in violation of the law if they don’t cover it, not because of what OPM did today, but because it’s a covered category in job discrimination,” Keisling said. “Trans people are protected by Title VII. We think it’s illegal sex discrimination if they exclude care for trans people that they allow other people to have.”

A White House official, speaking without attribution, also weighed in the policy change in response to an inquiry from the Washington Blade.

“The White House defers to OPM on how the FEHB program should be run, but we agree that access to appropriate medical care should be based on scientific and clinical evidence,” the official said.

The policy comes on the heels of a recent decision from an independent appeals board within the Department of Health & Human Services to allow Medicare to provide coverage for gender reassignment surgery. It also follows D.C. Mayor Vincent Gray’s decision to require health insurers to provide transgender-related care to D.C. residents.

Jeff Krehely, HRC’s vice president and chief foundation officer, said developments like these — as well as media attention to Laverne Cox, star of “Orange is the New Black” — is raising awareness for transgender issues.

“These victories are undoubtedly improving the lives of transgender people across the country — improving access to health care and providing critical protections on the job and beyond,” Krehely said. “However, the increased visibility of transgender people, like Laverne Cox, has an even more personal impact, most importantly on our youth.”

Rea Carey, executive director of the National Gay & Lesbian Task Force, also praised the change, calling it “yet another victory” in the struggle for full health coverage for transgender people.

“This affirms what the medical community has long stood behind; indeed every major medical association has gone on the record in support of fully-inclusive health insurance options for transgender people, because no health insurance company should get to decide whether a transgender person has access to the medical care their doctor prescribes,” Carey said. “We commend the Obama administration for standing on the right side of history, and look forward to the day when every health insurance plan in America is affirmatively required to offer the full range of medical care transgender people need.”

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

6 Comments
  • About time Validates the decision about 5 years ago by the state gay group I support to add T for Trans gender to the LGB designation and supported issues

    I count 14 states on the following list along with a large number of municipalities

    Add MD as #15 where I live – the bill was passed a couple mos ago. An attempt to referendum it failed

  • Finally, health insurance coverage is based on established medical consensus. This is long overdue. Coverage should be based on what has been researched, tested, and proven effective, ss this has been. And is considered medically appropriate treatment by every professional medical association. Coverage should be based on what is proven required and effective for treatment. It should not be based on opinion or an individuals view of morality. This is good news, and blessed be.

  • Willoann Liddle

    This requirement is long over due..FEHB providers should be required to provide full Transistion related services to Transexuals..Many private plans include this sevice for OPM/FEHB to do is fantasic…Thank You!!!

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