Medicare ban on sex reassignment surgery lifted

Federal board rules procedures are medically necessary for people who don't identify with their biological sex
Associated Press
May 31, 2014

Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled Friday in a groundbreaking decision that recognizes the procedures are medically necessary for people who don't identify with their biological sex.

Ruling in favor of a 74-year-old transgender Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency's Departmental Appeals Board said there was no justification for a three-decade-old HHS rule excluding such surgeries from procedures covered by the national health program for the elderly and disabled.

"Sometimes I am asked aren't I too old to have surgery. My answer is how old is too old?" the veteran, Denee Mallon, of Albuquerque, New Mexico, said in an email interview before the board issued its decision. "When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."

Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government.

Instead, the lifting of the coverage ban means they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals stating that surgery is recommended in their individual case, Levi said.

No statistics exist on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at the University of California, Los Angeles, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.

The cost of gender reassignment surgery varies, but typically ranges from $7,000 to $50,000, according to the Transgender Law Center in Oakland, California.

In Friday's ruling, the appeals board said that HHS lacked sufficient evidence in 1981 when it made a "national coverage determination" holding that Medicare recipients were ineligible for what it then called "transsexual surgery" because the procedure was too controversial, experimental, and medically risky.

The panel went on to say that regardless of what the record showed then, studies and experts have since shown the efficacy of surgical interventions as a treatment for gender dysphoria, the diagnosis given to people who experience extreme distress due to the disconnect between their birth sex and their gender identity.

"We have no difficulty concluding that the new evidence, which includes medical studies published in the more than 32 years since issuance of the 1981 report underlying the NCD, outweighs the NCD record and demonstrates that transsexual surgery is safe and effective and not experimental. Thus, as we discuss below, the grounds for the ...exclusion of coverage are not reasonable," the civilian panel said.

The appeals board's decisions are binding on HHS unless they are appealed in federal court. The Centers for Medicare and Medicaid Services, the agency within HHS that manages Medicare, opted not to defend the transgender surgery exclusion before the five-member board and had initiated the process for lifting it on its own before Mallon filed her complaint.

The ruling does not apply to Medicaid, which provides health coverage for individuals and families with low-incomes and is regulated by the states. Some states have exclusions on sex reassignment surgeries and the sex hormones transgender people often take during their transitions, while others evaluate claims on a case-by-case basis.

Transgender health advocates said that because private insurance companies and Medicaid programs often take their cues from the federal government on what is considered medically necessary, elective or experimental, the decision could pave the way for sex-reassignment surgeries to be a routinely covered benefit.

Mallon was born a man and identifies as a woman.

"When I learned that Medicare denies the essential care I need, I remember saying 'This is not right. They're relying on these archaic reasons to deny me the care my doctor agrees I need? I knew I had to do something to challenge that," Mallon said.




Medicaid doesn't pay for "sex reassignment surgery."

Doesn't that leave the 'deserving' poor at a financial disadvantage?

Perhaps this is an issue that the Dems should include in their mid-term elections political platform?


My three year old thinks he is a dinosaur...I think medicare should pay for his species identification disorder...and by medicare I mean YOU.


Pure BS from the gay and extreme left. They steal my money in the name of taxes, MURDER REAL Vets in the VA by putting them on wait lists until they die, but this is ok and will be made into a RUSH type surgery. And the left accuse those in religion as being inhuman. The serve the deranged and want those who really need help in the gutters to die.


It wasn't the "extreme left" who put vets on waiting lists. If anything, I'm betting that we'll find out that it was Republicans who are at fault with the VA issue. Considering Republican senators recently voted to deny funding for veterans' health benefits, I don't think that anyone who is actually paying attention believes that the GOP cares a whit about veterans.

Your comment is exactly what we would expect from a Republican. You only believe in funding things that directly benefit you and those closest to you. In your case, I would guess that means that you believe there should be funding for Viagra, but not for anything else that is remotely related to sex.

We Dems believe that everyone is of equal value. We also believe that the best examples of derangement can be found with those who watch Fox News religiously.


Re: "You only believe in funding things that directly benefit you and those closest to you."

With that in mind:

So what about it?

Should Medicaid pay for sex reassignment surgery?


coasterfan is such a silly man


Viagra funding? Heck no! Impotence was God's way of letting women finally sleep at night. My opinion anyways.

Stop It



"The issue of Iran sanctions ... has nothing to do with the needs of veterans," complained Senate Veterans' Affairs Committee Chairman Bernard Sanders of Vermont, the main sponsor of the bill.

Do you mean THIS vote? The one that had the IRAN Sanctions linked to it. So that if anyone voted it down it automatically looked like they were voting DOWN Veterans? Democrats played that one well. Making it look like the Republicans were against Veterans. And you fell for it too. Too bad you aren't telling what else was in the bill.

Darwin's choice

Typical of the obamabots. Typical demorats also. Coasterfan is sucking up to be the next knob polisher for obama. He's been practicing lying every time he comments, but, alas, he's no where near the caliber of suck ups above him.....


The "one subject at a time" act would solve that little problem once and for all by prohibiting the addition of unrelated amendments to bills under consideration. Bills can still be amended, of course, but the amendments would have to relate directly to that particular bill.

As long as I can remember, bills that might otherwise have been decent are getting politicians in trouble with constituents because of their votes that ended up approving or denying things ADDED to the bill. In this particular instance, it was one amendment itself that proved so onerous that it demanded a "no" vote from some.

The "one subject at a time" act is written and ready to go (it's available online for anybody who would like to read it for themselves), but it's had a hard time getting sponsors. Why? It's not because the bill itself is bad, but rather because too many politicians have used the amendment process to secure pork and don't want to lose the ability to grab out of the cookie jar whenever there's a "must pass" measure to which they can attach their own little money-pits.

This isn't a Democrat OR a Republican failing. BOTH sides have abused the he11 out of the process with their amendments. And stopping such abuse shouldn't be a partisan issue, either. Coasterfan, wouldn't you love to see it made impossible for Republicans to attach some creationist curriculum funding to a bill necessary to ensure our soldiers get paid next month?

Anything worthy of government funding (in my opinion, not much is, but that isn't the point) ought to be able to stand on its own! (Waste within budgets, such crystal and landscaping at the State Department, is another matter.)

The Hero Zone's picture
The Hero Zone

Perhaps you'd expect a reply from me, but something you said caught my eye. It was, "We Dems believe that everyone is of equal value."

Everyone is not of equal "value". Saying such a thing let alone possibly pining for such a system that enforces it is probably one of the most inhumane things you can do. Perhaps you meant something else? But I can only go off what you go here.

People are born with different abilities, capabilities, interests, and such. Some people work smarter, harder, or better than others. Others even through no fault of their own are born with handicaps or other disadvantages. Some jobs pay less than others because of the skills needed within the same company let alone among the myriad ones out there that even do the same thing. Some strive for more work experience or education than others.

Equal value (monetary or ability to interact with/produce for society), is nonexistent. Where I can agree with a concept of equality is that everyone is deserving of equal opportunities to succeed or fail by their own efforts. Equality before the law, too, is important so that the poorest among us can still be defended in court as the richest among us. The least intelligent can be represented fairly against those with greater intellect.

Equal value as I understand your sentiment is a horrible glass ceiling for humanity and quite a negative view of a person to take that they can never be any greater than what you think they should be because of someone else's differences. If nothing else wouldn't that make you no better than your much-hated Republican counterparts in humanity?


You're right, Hero, but that's not a unique viewpoint among progressives. They demand EQUALITY! But that's not what they want. What they REALLY want is equal OUTCOME. And that's a whole 'nother kettle of fish, subject to the variables you gave above.

People are NOT equal. They're equivalent, perhaps, as far as their humanity goes, and nobody has NO value. Equal opportunity? Sure! But that's also been bastardized by progressives. Should I have the opportunity to be a professional basketball player? Okay, sure. Nobody handcuffed me to a fence and told me I couldn't try out. But at my height (short) and my skill level in basketball (non-existent), merely having the opportunity to show up at an arena means diddly.

People are NOT equal. And unless you want no more geniuses, no more star athletes, no more beautiful models, no more Oscar-winning actors, no more brilliant CEOs or inventors, and no more LEADERS, they never will be.

The Hero Zone's picture
The Hero Zone

It is not unique and what's sadder is that what is supposedly done in the name of compassion and humanity can do just the opposite. This came to mind:

“No one believes more firmly than Comrade Napoleon that all animals are equal. He would be only too happy to let you make your decisions for yourselves. But sometimes you might make the wrong decisions, comrades, and then where should we be?” - Animal Farm

But even when facing those who are "more equal than others" there is still hope. This quote, for example:

"From time to time we've been tempted to believe that society has become too complex to be managed by self-rule, that government by an elite group is superior to government for, by, and of the people. Well, if no one among us is capable of governing himself, then who among us has the capacity to govern someone else?" - President "He-Who-Shall-Not-Be-Named"


I say the repubs should put a ban on this up for a vote in Congress. Let the Dems go on record saying it is OK to squander taxpayer money on such nonsense that is not medically necessary. It should bode well for them in the midterms. While the public may support gay marriage, they don't support bankrolling this sort of nonsense.


So when I get older, and I don't identify with my breasts sagging, can I get reconstructive surgery for them. Medicare will cover it?


Welcome to the world of the liberal. You get what you vote for…


But, but, if you don't vote for it you'll be called racist.


The belief by a person with X and Y chromosones that they are female is no less a delusion than the belief by a human that they are a giraffe or a rutabaga, medical technology's ability to mutilate their body to conform to the delusion notwithstanding. Taxpayers have no duty to indulge such delusions.


So , you are against anything that is ( in your view ) unnatural for medicare or medicaid to pay for ? What about reconstructive surgery for a facial deformity ( Not life threatening ) but still a burden for the one with this affliction . From what I understand this is how some people who see themselves as the opposite sex of how they were born , feel (deformed) . With the way our technology is advancing I can envision a day when we will be able to shed our natural forms like changing clothes . It may seem taboo now , but so was getting tattoos at one point . Now it seems everyone has at least one . Times are a changin' .


Re: "tattoos" "Now it seems everyone has at least one ."

Have read stories where yrs. later they want them removed.

Have also read that removing them costs approx. six times what it cost to put them on.

Yea, Medicare and Medicaid ought to pay for tattoo removal too, right?


Don't get your knickers in a bunch Contango . We all pay into the system anyway , so why can't we all get whatever we want from it as well ? Some act like they are the only ones contributing to medicare or medicaid through taxes . If someone doesn't want to pay taxes then don't , and see how that works out for you , instead of whining like little b!tches . ; )))


Re: "We all pay into the system anyway , so why can't we all get whatever we want from it as well?"

Reads like a fine prescription for fiscal & financial bankruptcy - and then EVERYONE loses.


All great empires eventually fall . That has been proven time and time again , but we can try to enjoy it while it lasts . The world has survived without money before , it will do so again . Que sinister laugh ; ))))))


Re:"We all pay into the system anyway , so why can't we all get whatever we want from it as well ?"

Well I do pay into the system and I want to be reimbursed for my $5,000 hearing aids and also my plavix with no co-pay the same as birth control products are given to women with no co-pay then I will be satisfied


Fair enough. But I'd also note that I actually paid for my own tattoos...


and, if I know you, should you grow tired of them, you won't be asking anyone else to pay for their removal.


Also entirely true. But for the record, I was also responsible enough to WAIT before I got my first ink. Oh, I WANTED a tattoo from the time I was about 15. But, like diamonds, tattoos are forever so I waited until I was sure there was something I wanted on my body permanently (even now, removal is imperfect, subject to variables ranging from skin condition to ink color to healing abilities)! Besides, I'm kind of a girl when it comes to pain. Tattoos hurt; I'm told removal makes getting the tattoo in the first place seem like a walk in the park!


Actually, the newer laser techniques are not painful, and are very effective, but they cost an arm and a leg.


Deformities are defined by how they differ from the statistical norm of the human body, not by the individual's precious feelings.

JMOP summed it up nicely - some women might FEEL deformed because they don't have the breasts of a centerfold model.

I shouldn't have to pay to indulge other peoples' whims, hangups, or delusions.

I FEEL deformed behind the wheel of anything less than a Ferrari.