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.
Rehoboth Beach
BLUF leather social set for April 10 in Rehoboth
Attendees encouraged to wear appropriate gear
Diego’s in Rehoboth Beach hosts a monthly leather happy hour. April’s edition is scheduled for Friday, April 10, 5-7 p.m. Attendees are encouraged to wear appropriate gear. The event is billed as an official event of BLUF, the free community group for men interested in leather. After happy hour, the attendees are encouraged to reconvene at Local Bootlegging Company for dinner, which allows cigar smoking. There’s no cover charge for either event.
District of Columbia
Celebrations of life planned for Sean Bartel
Two memorial events scheduled in D.C.
Two celebrations of life are planned for Sean Christopher Bartel, 48, who was found deceased on a hiking trail in Argentina on or around March 15. Bartel began his career as a television news reporter and news anchor at stations in Louisville, Ky., and Evansville, Ind., before serving as Senior Video Producer for the D.C.-based International Brotherhood of Electrical Workers union from 2013 to 2024.
A memorial gathering is planned for Friday, April 10, 11:30 a.m.-1:30 p.m. at the IBEW International Office (900 7th St., N.W.), according to a statement by the DC Gay Flag Football League, where Bartel was a longtime member. A celebration of life is planned that same evening, 6-8 p.m. at Trade (1410 14th St., N.W.).
Puerto Rico
The ‘X’ returns to court
1st Circuit hears case over legal recognition of nonbinary Puerto Ricans
Eight months ago, I wrote about this issue at a time when it had not yet reached the judicial level it faces today. Back then, the conversation moved through administrative decisions, public debate, and political resistance. It was unresolved, but it had not yet reached this point.
That has now changed.
Lambda Legal appeared before the 1st U.S. Court of Appeals in Boston, urging the court to uphold a lower court ruling that requires the government of Puerto Rico to issue birth certificates that accurately reflect the identities of nonbinary individuals. The appeal follows a district court decision that found the denial of such recognition to be a violation of the U.S. Constitution.
This marks a turning point. The issue is no longer theoretical. A court has already determined that unequal treatment exists.
The argument presented by the plaintiffs is grounded in Puerto Rico’s own legal framework. Identity birth certificates are not static historical records. They are functional documents used in everyday life. They are required to access employment, education, and essential services. Their purpose is practical, not symbolic.
Within that framework, the exclusion of nonbinary individuals does not stem from a legal limitation. Puerto Rico already allows gender marker corrections on birth certificates for transgender individuals under the precedent established in Arroyo Gonzalez v. Rosselló Nevares. In addition, the current Civil Code recognizes the existence of identity documents that reflect a person’s lived identity beyond the original birth record.
The issue lies in how the law is applied.
Recognition is granted within specific categories, while those who do not identify within that binary structure remain excluded. That exclusion is now at the center of this case.
Lambda Legal’s position is straightforward. Requiring individuals to carry documents that do not reflect who they are forces them into misrepresentation in essential aspects of daily life. This creates practical barriers, exposes them to scrutiny, and places them in a constant state of vulnerability.
The plaintiffs, who were born in Puerto Rico, have made clear that access to accurate identification is not symbolic. It is a basic condition for moving through the world without contradiction imposed by the state.
The fact that this case is now being addressed in the federal court system adds another layer of significance. This is not a pending policy discussion or a legislative proposal. It is a constitutional question. The analysis is not about political preference, but about rights and equal protection under the law.
This case does not exist in isolation.
It unfolds within a broader context in which debates over identity and rights have increasingly been shaped by the growing influence of conservative perspectives in public policy, both in the United States and in Puerto Rico. At the local level, this influence has been reflected in legislative discussions where religious arguments have begun to intersect with decisions that should be grounded in constitutional principles. That intersection creates tension around the separation of church and state and has direct consequences for access to rights.
Recognizing this context is not an attack on faith or religious practice. It is an acknowledgment that when certain perspectives move into the realm of public authority, they can shape outcomes that affect specific communities.
From within Puerto Rico, this is not a distant debate. It is a lived reality. It is present in the difficulty of presenting identification that does not match one’s identity, and in the consequences that follow in workplaces, schools, and government spaces.
The progression of this case introduces the possibility of change within the applicable legal framework. Not because it resolves every tension surrounding the issue, but because it establishes a legal examination of a practice that has long operated under exclusion.
Eight months ago, the conversation centered on ongoing developments. Today, there is already a judicial finding that identifies a violation of rights. What remains is whether that finding will be upheld on appeal.
That process does not guarantee an immediate outcome, but it shifts the ground.
The debate is no longer theoretical.
It is now before the courts.
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