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.
District of Columbia
Bowser appoints first nonbinary person to Cabinet-level position
Peter Stephan named Office of Disability Rights interim director
D.C. Mayor Muriel Bower has named longtime disability rights advocate Peter L. Stephan, who identifies as nonbinary, as interim director of the D.C. Office of Disability Rights.
The local transgender and nonbinary advocacy group Our Trans Capital and the LGBTQ group Capital Stonewall Democrats issued a joint statement calling Stephan’s appointment an historic development as the first-ever appointment of a nonbinary person to a Cabinet-level D.C. government position.
“This milestone appointment recognizes Stephan’s extensive expertise in disability rights advocacy and marks a historic advancement for transgender and nonbinary representation in District government leadership,” the statement says.
The statement notes that Stephan, an attorney, held the position of general counsel at the Office of Disability Rights immediately prior to the mayor’s decision to name him interim director.
The mayor’s office didn’t immediately respond to a question from the Washington Blade asking if Bowser plans to name Stephan as the permanent director of the Office of Disability Rights. John Fanning, a spokesperson for D.C. Council member Anita Bonds (D-At-Large), said the office’s director position requires confirmation by the Council.
Stephan couldn’t immediately be reached for comment.
“At a time when trans and nonbinary people ae under attack across the country, D.C. continues to lead by example,” said Stevie McCarty, president of Capital Stonewall Democrats. “This appointment reflects what we have always believed that our community is always strongest when every voice is represented in government,” he said.
“This is a historic step forward,” said Vida Rengel, founder of Our Trans Capital. “Interim Director Stephan’s career and accomplishments are a shining example of the positive impact that trans and nonbinary public servants can have on our communities,” according to Rangel.
Bulgaria
Top EU court issues landmark transgender rights ruling
Member states must allow name, gender changes on ID documents
The European Union’s highest court on Thursday ruled member states must allow transgender people to legally change their name and gender on ID documents.
The EU Court of Justice in Luxembourg issued the ruling in the case of “Shipova,” a trans woman from Bulgaria who moved to Italy.
“Shipova” had tried to change her gender and name on her Bulgarian ID documents, but courts denied her requests for nearly a decade.
A ruling the Bulgarian Supreme Court of Cassation issued in 2023 essentially banned trans people from legally changing their name and gender on ID documents. Two Bulgarian LGBTQ and intersex rights groups — the Bilitis Foundation and Deystvie — and ILGA-Europe and TGEU – Trans Europe and Central Asia supported the plaintiff and her lawyers.
“Because her life in Italy also depended on her Bulgarian documents, the lack of documents reflecting her lived gender creates an obstacle to her right to move and reside within EU member states,” said the groups in a press release. “This mismatch between her gender identity and expression and her gender marker in her official documents leads to discrimination in all areas of life where official documents are required. This includes everyday activities such as going to the doctor and paying for groceries by card, finding employment, enrolling in education, or obtaining housing.”
Denitsa Lyubenova, a lawyer with Desytvie, in the press release said the case “concerns the dignity, equality, and legal certainty of trans people in Bulgaria.” TGEU Senior Policy Officer Richard Köhler also praised the ruling.
“Today, the EU Court of Justice has taken an important step towards a right to legal gender recognition in the EU,” said Köhler. “Member states must allow their nationals living in another member state to change their gender data in public registries and identity cards to ensure they can fully enjoy their freedom of movement. National laws or courts cannot stand in their way.”
“Thousands of trans people in the EU are breathing a sigh of relief today,” added Köhler.
Senegal
Senegalese lawmakers approve bill to further criminalize homosexuality
A dozen men arrested in February for ‘unnatural acts’
Senegalese lawmakers on Wednesday approved a bill that would further criminalize consensual same-sex sexual relations in the country.
The Associated Press notes the measure that Prime Minister Ousmane Sonko introduced in February would increase the penalty for anyone convicted of engaging in consensual same-sex sexual relations from one to five years in prison to five to 10 years. The AP further indicates the bill would prohibit the “promotion” or “financing” of homosexuality in the country.
The bill passed with near unanimous support. Only three of 135 MPs abstained.
President Bassirou Diomaye Faye is expected to sign the measure.
The National Assembly in 2021 rejected a bill that would have further criminalized homosexuality in Senegal.
Senegalese police last month arrested a dozen men and charged them with committing “unnatural acts.”
Volker Türk, the U.N. high commissioner for human rights, in a statement described the bill as “deeply worrying.”
“It flies in the face of the sacrosanct human rights we all enjoy: the rights to respect, dignity, privacy, equality and freedoms of expression, association, and peaceful assembly,” he said.
Türk also urged Faye not to sign the bill.
“I urge the president not to sign this harmful law into effect, and for authorities to repeal the existing discriminatory law and to uphold the human rights of all in Senegal, without discrimination,” said Türk.
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