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Medicare to examine ban on gender reassignment surgery

Rationale for policy ‘not complete and adequate’

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transgender, caduceus, medicare, gay news, Washington Blade, health
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.

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Congress

Van Hollen speaks at ‘ICE Out for Good’ protest in D.C.

ICE agent killed Renee Nicole Good in Minneapolis on Jan. 7

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U.S. Sen. Chris Van Hollen (D-Md.) speaks at the 'ICE Out for Good' rally in D.C. (Washington Blade photo by Michael Key)

U.S. Sen. Chris Van Hollen (D-Md.) is among those who spoke at an “ICE Out for Good” protest that took place outside U.S. Customs and Border Protection’s headquarters in D.C. on Tuesday.

The protest took place six days after a U.S. Immigration and Customs Enforcement agent shot and killed Renee Nicole Good, a 37-year-old woman in Minneapolis.

Good left behind her wife and three children.

(Video by Michael K. Lavers)

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U.S. Supreme Court

Competing rallies draw hundreds to Supreme Court

Activists, politicians gather during oral arguments over trans youth participation in sports

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Hundreds gather outside the U.S. Supreme Court on Tuesday. (Washington Blade photo by Michael Key)

Hundreds of supporters and opponents of trans rights gathered outside of the United States Supreme Court during oral arguments for Little v. Hecox and West Virginia v. B.P.J. on Tuesday. Two competing rallies were held next to each other, with politicians and opposing movement leaders at each.

“Trans rights are human rights!” proclaimed U.S. Sen. Ed Markey (D-Mass.) to the crowd of LGBTQ rights supporters. “I am here today because trans kids deserve more than to be debated on cable news. They deserve joy. They deserve support. They deserve to grow up knowing that their country has their back.”

U.S. Sen. Ed Markey (D-Mass.) speaks outside of the U.S. Supreme Court on Tuesday. (Washington Blade photo by Michael Key)

“And I am here today because we have been down this hateful road before,” Markey continued. “We have seen time and time again what happens when the courts are asked to uphold discrimination. History eventually corrects those mistakes, but only after the real harm is done to human beings.”

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U.S. Education Secretary Linda McMahon spoke at the other podium set up a few feet away surrounded by signs, “Two Sexes. One Truth.” and “Reality Matters. Biology Matters.”

“In just four years, the Biden administration reversed decades of progress,” said McMahon. “twisting the law to urge that sex is not defined by objective biological reality, but by subjective notion of gender identity. We’ve seen the consequences of the Biden administration’s advocacy of transgender agendas.”

From left, U.S. Education Secretary Linda McMahon and U.S. Rep. Mark Takano (D-Calif.) speak during the same time slot at competing rallies in front of the U.S. Supreme Court on Tuesday. Takano addresses McMahon directly in his speech. (Washington Blade photo by Michael Key)

U.S. Rep. Mark Takano (D-Calif.), chair of the Congressional Equality Caucus, was introduced on the opposing podium during McMahon’s remarks.

“This court, whose building that we stand before this morning, did something quite remarkable six years ago.” Takano said. “It did the humanely decent thing, and legally correct thing. In the Bostock decision, the Supreme Court said that trans employees exist. It said that trans employees matter. It said that Title VII of the Civil Rights Act protects employees from discrimination based on sex, and that discrimination based on sex includes discrimination based on gender identity and sexual orientation. It recognizes that trans people have workplace rights and that their livelihoods cannot be denied to them, because of who they are as trans people.”

“Today, we ask this court to be consistent,” Takano continued. “If trans employees exist, surely trans teenagers exist. If trans teenagers exist, surely trans children exist. If trans employees have a right not to be discriminated against in the workplace, trans kids have a right to a free and equal education in school.”

Takano then turned and pointed his finger toward McMahon.

“Did you hear that, Secretary McMahon?” Takano addressed McMahon. “Trans kids have a right to a free and equal education! Restore the Office of Civil Rights! Did you hear me Secretary McMahon? You will not speak louder or speak over me or over these people.”

Both politicians continued their remarks from opposing podiums.

“I end with a message to trans youth who need to know that there are adults who reject the political weaponization of hate and bigotry,” Takano said. “To you, I say: you matter. You are not alone. Discrimination has no place in our schools. It has no place in our laws, and it has no place in America.”

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District of Columbia

Ruby Corado sentenced to 33 months in prison

Former Casa Ruby director pleaded guilty to wire fraud in 2024

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Ruby Corado (Washington Blade photo by Ernesto Valle)

A federal judge on Jan. 13 sentenced Ruby Corado, the founder and former executive director of the now closed D.C. LGBTQ community services organization Casa Ruby, to 33 months of incarceration for a charge of wire fraud to which she pleaded guilty in July 2024.

U.S. District Court Judge Trevor M. McFadden handed down the sentence that had been requested by prosecutors with the Office of the U.S. Attorney for the District of Columbia after Corado’s sentencing had been postponed six times for various reasons.

The judge also sentenced her to 24 months of supervised release upon her completion of incarceration.  

In addition to the sentence of incarceration, McFadden agreed to a request by prosecutors to hold Corado responsible for “restitution” and “forfeiture” in the amount of $956,215 that prosecutors have said she illegally misappropriated from federal loans obtained by Casa Ruby.

The charge to which she pleaded guilty is based on allegations that she diverted at least $180,000 “in taxpayer backed emergency COVID relief funds to private offshore bank accounts,” according to court documents.  

Court records show FBI agents arrested Corado on March 5, 2024, at a hotel in Laurel, Md., shortly after she returned to the U.S. from El Salvador, where authorities say she moved in 2022. Prosecutors have said in charging documents that she allegedly fled to El Salvador, where she was born, after “financial irregularities at Casa Ruby became public,” and the LGBTQ organization ceased operating.

Shortly after her arrest, another judge agreed to release Corado into the custody of her niece in Rockville, Md., under a home detention order. But at an Oct. 14, 2025, court hearing at which the sentencing was postponed after Corado’s court appointed attorney withdrew from the case, McFadden ordered Corado to be held in jail until the time of her once again rescheduled sentencing.   

Her attorney at the time, Elizabeth Mullin, stated in a court motion that her reason for withdrawing from the case was an “irreconcilable breakdown in the attorney-client relationship.”

Corado’s newly retained attorney, Pleasant Brodnax, filed a 25-page defense Memorandum in Aid of Sentencing on Jan. 6, calling for the judge to sentence Corado only to the time she had already served in detention since October.  

Among other things, Brodnax’s defense memorandum disputes the claim by prosecutors that Corado improperly diverted as much as $956,215 from federally backed loans to Casa Ruby, saying the total amount Corado diverted was $200,000. Her memo also states that Corado diverted the funds to a bank account in El Salvador for the purpose of opening a Casa Ruby facility there, not to be used for her personally.

“Ms. Corado has accepted responsibility for transferring a portion of the loan disbursements into another account she operated and ultimately transferring a portion of the loan disbursements to an account in El Salvador,” the memo continues.

“Her purpose in transferring funds to El Salvador was to fund Casa Ruby programs in El Salvador,” it says, adding, “Of course, she acknowledges that the terms of the loan agreement did not permit her to transfer the funds to El Salvador for any purpose.”

In his own 16-page sentencing recommendation memo, Assistant U.S. Attorney John Borchert, the lead prosecutor in the case, said Corado’s action amounted at the least to fraud.

“The defendant and Casa Ruby received no less than $1.2 million in taxpayer backed funds during the COVID-19 global health crisis,” he memo states. “But rather than use those funds to support Casa Ruby’s mission as the defendant promised, the defendant further contributed to its demise by unlawfully transferring no less than $180,000 of these federal emergency relief funds into her own private offshore bank accounts,” it says.

“Then, when media reports suggested the defendant would be prosecuted for squandering Casa Ruby’s government funding, she sold her home and fled the country,” the memo states. “Meanwhile, the people who she had promised to pay with taxpayer-backed funds – her employees, landlord, and vendors – were left behind flat broke.”

A spokesperson for the U.S. Attorney’s office and Corado’s attorney didn’t immediately respond to a request from the Washington Blade for comment on the judge’s sentence. 

“Ms. Corado accepts full responsibility for her actions in this case,” defense attorney Brodnax says in her sentencing memo. “She acknowledges the false statements made in the loan applications and that she used some of the money outside the United States,” it says.

“However, the money was still utilized for the same purpose and intention as the funds used in the United States, to assist the LGBTQ community,” it states. “Ms. Corado did not use the money to buy lavish goods or fund a lavish lifestyle.”  

Brodnax also states in her memo that as a transgender woman, Corado could face abuse and danger in a correctional facility where she may be sent if sentenced to incarceration.   

“Ruby Corado committed a crime, she is now paying the price,” said D.C. LGBTQ rights advocate Peter Rosenstein. “While it is sad in many ways, we must remember she hurt the transgender community with what she did, and in many ways they all paid for her crime.”

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