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
D.C. pays $500,000 to settle lawsuit brought by gay Corrections Dept. employee
Alleged years of verbal harassment, slurs, intimidation
The D.C. government on Feb. 5 agreed to pay $500,000 to a gay D.C. Department of Corrections officer as a settlement to a lawsuit the officer filed in 2021 alleging he was subjected to years of discrimination at his job because of his sexual orientation, according to a statement released by the American Civil Liberties Union of D.C.
The statement says the lawsuit, filed on behalf of Sgt. Deon Jones by the ACLU of D.C. and the law firm WilmerHale, alleged that the Department of Corrections, including supervisors and co-workers, “subjected Sgt. Jones to discrimination, retaliation, and a hostile work environment because of his identity as a gay man, in violation of the D.C. Human Rights Act.”
Daniel Gleick, a spokesperson for D.C. Mayor Muriel Bowser, said the mayor’s office would have no comment on the lawsuit settlement. The Washington Blade couldn’t immediately reach a spokesperson for the Office of the D.C. Attorney General, which represents the city against lawsuits.
Bowser and her high-level D.C. government appointees, including Japer Bowles, director of the Mayor’s Office of LGBTQ Affairs, have spoken out against LGBTQ-related discrimination.
“Jones, now a 28-year veteran of the Department and nearing retirement, faced years of verbal abuse and harassment from coworkers and incarcerated people alike, including anti-gay slurs, threats, and degrading treatment,” the ACLU’s statement says.
“The prolonged mistreatment took a severe toll on Jones’s mental health, and he experienced depression, Post-Traumatic Stress Disorder, and 15 anxiety attacks in 2021 alone,” it says.
“For years, I showed up to do my job with professionalism and pride, only to be targeted because of who I am,” Jones says in the ACLU statement. “This settlement affirms that my pain mattered – and that creating hostile workplaces has real consequences,” he said.
He added, “For anyone who is LGBTQ or living with a disability and facing workplace discrimination or retaliation, know this: you are not powerless. You have rights. And when you stand up, you can achieve justice.”
The settlement agreement, a link to which the ACLU provided in its statement announcing the settlement, states that plaintiff Jones agrees, among other things, that “neither the Parties’ agreement, nor the District’s offer to settle the case, shall in any way be construed as an admission by the District that it or any of its current or former employees, acted wrongfully with respect to Plaintiff or any other person, or that Plaintiff has any rights.”
Scott Michelman, the D.C. ACLU’s legal director said that type of disclaimer is typical for parties that agree to settle a lawsuit like this.
“But actions speak louder than words,” he told the Blade. “The fact that they are paying our client a half million dollars for the pervasive and really brutal harassment that he suffered on the basis of his identity for years is much more telling than their disclaimer itself,” he said.
The settlement agreement also says Jones would be required, as a condition for accepting the agreement, to resign permanently from his job at the Department of Corrections. Michelman said Jones has been on leave from work for a period of time, but he did not know how long. Jones couldn’t immediately be reached for comment.
“This is really something that makes sense on both sides,” Michelman said of the resignation requirements. “The environment had become so toxic the way he had been treated on multiple levels made it difficult to see how he could return to work there.”
Virginia
Spanberger signs bill that paves way for marriage amendment repeal referendum
Proposal passed in two successive General Assembly sessions
Virginians this year will vote on whether to repeal a state constitutional amendment that defines marriage as between a man and a woman.
Democratic Gov. Abigail Spanberger on Friday signed state Del. Laura Jane Cohen (D-Fairfax County)’s House Bill 612, which finalized the referendum’s language.
The ballot question that voters will consider on Election Day is below:
Question: Should the Constitution of Virginia be amended to: (i) remove the ban on same-sex marriage; (ii) affirm that two adults may marry regardless of sex, gender, or race; and (iii) require all legally valid marriages to be treated equally under the law?
Voters in 2006 approved the Marshall-Newman Amendment.
Same-sex couples have been able to legally marry in Virginia since 2014. Former Gov. Glenn Youngkin, who is a Republican, in 2024 signed a bill that codified marriage equality in state law.
Two successive legislatures must approve a proposed constitutional amendment before it can go to the ballot.
A resolution to repeal the Marshall-Newman Amendment passed in the General Assembly in 2025. Lawmakers once again approved it last month.
“20 years after Virginia added a ban on same-sex marriage to our Constitution, we finally have the chance to right that wrong,” wrote Equality Virginia Executive Director Narissa Rahaman on Friday in a message to her group’s supporters.
Virginians this year will also consider proposed constitutional amendments that would guarantee reproductive rights and restore voting rights to convicted felons who have completed their sentences.
District of Columbia
D.C. non-profits find creative ways to aid the unhoused amid funding cuts
City’s poor economic mobility makes it easier to slip into homelessness
Homelessness is unlikely to disappear entirely, but it can be minimized and controlled.
That principle guides Everyone Home Executive Director Karen Cunningham’s approach to homeless support and prevention in D.C.
“There’s always going to be some amount of people who have a crisis,” Cunningham said. “The goal is that if they become homeless, [it’s] rare, brief and non-recurring. And in order for that to be the case, we need to have steady investments in programs that we know work over time.”
Making those investments has proven to be an unprecedented challenge, however. Cunningham said non-profits and other organizations like Everyone Home are grappling with government funding cuts or stalls that threaten the work they do to support D.C.’s homeless population.
Despite a 9% decrease in homelessness from 2024 to 2025, advocates worry that stagnant funding will make that progress hard to sustain. Furthermore, D.C. has the worst unemployment rate in the country at 6.7% as of December. The city’s poor economic mobility makes it easier for people to slip into homelessness and harder to break free of it.
There’s a way forward, Cunningham said, but it’s going to take a lot of perseverance and creative solutions from those willing to stay in the fight.
Fighting through setbacks
Reduced funding from the city government has shifted the way Everyone Home operates.
In D.C.’s fiscal year 2026 budget proposal, homeless services and prevention programs saw stalled growth or financial reductions. Even just a few years ago, Cunningham said Everyone Home received a large influx of vouchers to help people who needed long-term supportive housing. The vouchers allowed the non-profit to break people free of the homeless cycle and secure stable housing.
However, those vouchers are scarce these days. Cunningham said the city is investing less in multi-year programs and more in programs that offer preventative and upfront support.
She said this reality has forced Everyone Home to stop operating its Family Rapid Rehab program, which helps families leave shelters and transition into permanent housing. Current funds couldn’t withstand the size of the program and Cunningham said very few organizations can still afford to run similar programs.
The Family Homelessness Prevention program, however, is thriving and expanding at Everyone Home due to its short-term nature. It provides families with 90-day support services to help them get back on track and secure stable finances and housing.
Everyone Home also offers a drop-in day center, where they provide people with emergency clothing, laundry, and meals, and has a street outreach team to support those who are chronically homeless and offer services to them.
Inconsistencies in financial support have created challenges in providing the necessary resources to those struggling. It’s led non-profits like Everyone Home to get creative with their solutions to ensuring no one has recurring or long spouts of homelessness.
“It’s really a sustained investment in these programs and services that can allow us to chip away, because if you put all these resources in and then take your foot off the gas, there’s always people entering the system,” Cunningham said. “And so we have to always be moving people out into housing.”
Getting people in and out of the homeless system isn’t easy due to D.C.’s struggle with providing accessible and affordable housing, D.C. Policy Center executive director Yesim Sayin said in a Nov. 16 Washington Blade article.
Sayin said that D.C.’s construction tailors to middle or upper class people who live in the city because work brought them there, but it excludes families and D.C. natives who may be on the verge of homelessness and have less geographic mobility.
Building more and building smarter ensures D.C.’s low-income population aren’t left behind and at risk of becoming homeless, Sayin said.
That risk is a common one in D.C. given its low economic mobility. Residents have less room to financially grow given the city’s high cost of living, making vulnerable communities more prone to homelessness.
With funding cuts for long-term programs, preventative programs have proven to be vital in supporting the homeless population. When someone becomes homeless, it can have a snowball effect on their life. They aren’t just losing a house –– they may lose their job, access to reliable transportation and food for their family.
Cunningham said resources like the Family Homelessness Prevention program allows people to grow and stabilize before losing crucial life resources.
“Helping people keep what they have and to try to grow that as much as possible is really important where there aren’t a lot of opportunities…for people to increase their income,” Cunningham said.
Through all the funding cuts and reduced services, D.C.’s homeless support organizations are still finding a path forward –– a path that many residents and families rely on to survive.
Pushing forward
Local non-profits and organizations like Everyone Home are the backbone of homeless support when all other systems fail.
When the White House issued an executive order directing agencies to remove homeless encampments on federal land, Coalition For The Homeless provided ongoing shelter to those impacted.
“We were asked by our funders to open two shelters at the time of the encampment policy announcement,” Lucho Vásquez, executive director of Coalition For The Homeless, said. “We opened the shelters on the same day of the request and have been housing 100 more people who are unhoused each night since August.”
This was achieved even after Coalition faced “severe cuts in funding for supportive and security services,” according to Vásquez. Staff members have taken on additional responsibilities to make up for the loss in security coverage and supportive services with no increase in pay, but Vásquez said they’re still trying to fill gaps left by the cuts.
Coalition offers free transitional housing, single room occupancy units and affordable apartments to people who were unhoused.
Coalition For The Homeless isn’t the only non-profit that’s had to step up its services amid dwindling resources. Thrive D.C. provides hot meals, showers, and winter clothes, which is especially important during the winter months.
Pathways to Housing D.C. offers housing services for people regardless of their situation or condition. Its “Housing First” teams house people directly from the streets, and then evaluate their mental and physical health, employment, addiction status, and education challenges to try to integrate them back into the community.
Covenant House is a homeless shelter for youth ages 18-24. They provide resources and shelter for youth “while empowering young people in their journey to independence and stability,” its website reads. Through its variety of programs, Friendship Place ended or prevented homelessness, found employment and provided life-changing services for more than 5,400 people.
These groups have made a huge local difference with little resources, but Cunningham said there are more ways for people to support those experiencing homelessness if they’re strapped for time or money. Aside from donating and volunteering, she said even simply showing compassion toward people who are struggling can go a long way.
Cunningham said compassion is something that’s been lost in the mainstream, with politicians and news anchors regularly directing hostile rhetoric toward homeless populations. But now more than ever, she said caring and understanding for fellow community members is key to moving forward and lifting those in need up.
“People sometimes feel invisible or that there’s a sense of hostility,” Cunningham said. “I think all of us can at least do that piece of recognizing people’s humanity.”
(This article is part of a national initiative exploring how geography, policy, and local conditions influence access to opportunity. Find more stories at economicopportunitylab.com.)
