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.

 

Comments

Contango

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?

herbie_hancock

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.

Truth2u

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.

coasterfan

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.

Contango

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?

goofus

coasterfan is such a silly man

JMOP's picture
JMOP

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

Stop It

lol...

ladydye_5

"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.
http://abcnews.go.com/blogs/poli...

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.....

SamAdams

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?

SamAdams

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"

KnuckleDragger

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.

JMOP's picture
JMOP

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?

thinkagain's picture
thinkagain

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

Nemesis

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

Nemesis

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.

Bluto

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' .

Contango

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?

Bluto

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 . ; )))

Contango

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.

Bluto

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 ; ))))))

anthras

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

SamAdams

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

Nemesis

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

SamAdams

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!

Nemesis

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

Nemesis

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.

jazzbo

We shouldn't be spending for sex changes.

As ugly as that guy is ..... he'd be better off being changed into a rutabaga.

Bluto

I seen a piece on how in Kentucky the state contributed 40 million in taxpayer money to a Noah's Ark themed amusement park , with dinosaurs included as some of the animals in this exhibit . What do you say , waste of taxpayer money or what ? If the wants of one group can be satisfied by the government , why can't another's ?

Contango

Thanks for the 'heads up.'

Slight correction:

"In 2011, the Kentucky Tourism Development Finance Authority granted approval for up to $43.1 million in sales tax rebates over 10 years."

http://www.usatoday.com/story/ne...

Guess the state's approaching it from an economic development standpoint.

Where's the economic development angle in taxpayer funded sex change operations?

jazzbo

Right.

Bluto

I guess there really isn't any economic development in sex changes for us as individual taxpayers , but it could make all the difference to the individual getting the sex change in terms of how well they fit into society and perhaps become a contributing member of society thus benefiting the whole . I know taxes suck but what can you do ? civilization isn't going to be cheap .: )

Contango

Re: "I know taxes suck but what can you do ? civilization isn't going to be cheap .: )"

So the political ruling class knows how to spend YOUR money better and more efficiently than YOU. Got it.

With that mentality, the fed govt. ought to just pay for the entire cost of that Noah's Ark park, right?

H*ll, let's put one in every state!

Bluto

Come on , We both know if taxes were a voluntary thing that this country wouldn't exist now . In a perfect world where we were all responsible for our own "frontage" and actually kept it up , there would be no need for government , but we all know how that story goes . Personal responsibility is great but the whole point of government is to make policy for all and not everyone is going to be happy all the time . Wow , that snow balled quickly !

jazzbo

Bluto -
Then we should fund people who think they are a poached egg.

We should fund mental health.

Bluto

Yes.

Bluto

I guess beauty is in the eye of the beholder ,but if you are one of the "beautiful people" you might just be too shallow to understand that ; )))

Contango

Why don't the LGBTs start a charity to help pay for the "rearrangements"?

Nah! 'Let govt. do it' is the typical liberal dumbed-down response.

Bluto

In my younger days I used to frequent a bar where the young lady bartender had a special tip jar for customers to contribute to a boob job . She actually got a lot of money towards that goal and did get the augmentation she wanted . I just don't see a transgender person getting the same enthusiasm for their cause from the general populace . Gov't may be some's only option .

SamAdams

So, does that mean you'll be contributing to my liposuction fund? And if you won't, does that mean I can demand that ALL taxpayers chip in for it? I mean, I'd look better and all, which means I'd feel better about myself, right? Yep, I'm pretty sure I need liposuction for the sake of my mental health! May I anticipate your contribution soon?

Bluto

The article states that a person would still have to get the proper recommendations from doctors in order to get approval for surgeries and that medicaid was excluded from these types of operations . I'm sure that the patient would have some monetary responsibilities as well even under medicare .

jazzbo

I realize that people don't have a choice of what body they get at birth but come on , get real.... Does he make you horny ? :))))

Bluto

Funny I thought we were trying to have an adult conversation about this article . Jazzbo , Why are you trying to bring this down to a childlike state ? If you got something meaningful to contribute , then please do , otherwise let the grown ups talk ; )))

jazzbo

You think that YOU are having an adult conversation about this article ?

Your logic is ridiculous.

(Are you trying to get a tax supported sex change too ?)

Bluto

How is it ridiculous ? Please explain .

jazzbo

Just reread ALL the past responses to you and maybe you'll figure it out.

Bluto

You are making no sense . My comments are not earth shattering , but yours seem to be of the angry jokester variety . You poor thing .

jazzbo

And you are... who ??? The lord of the comment section ?

Miss something ? -- "Just reread ALL the past responses - TO- you ..."

Bluto

I have , and all I see is point and counter point , except from you that is . As far as Lord of the comment section ? Maaaaybeee : ))))))

jazzbo

You have an overestimated sense of self.

Bluto

Hmmm , I guess your just the sensitive type . Go ahead , lashout if it helps those little feelings of yours . Maybe some day you'll grow some hard bark . You know sometimes I do think I have an over estimated sense of self worth , but then realize , naaaah I'm worth every cent . ; )))))

jazzbo

All I conclude about you is : You are right and everyone is wrong.

A little self deluded , aren't ya ?

Bluto

My motto is "There's nothing wrong with me , it's the rest of the world that's messed up" . Hee-hee !!!!

jazzbo

Case closed.

thinkagain's picture
thinkagain

Where's Mikey?

deertracker

The government should not be involved here at all. I respect your right to identify with your feelings but it's a personal matter.

Bluto

This person is a veteran and I don't think the government has any legitimate reason to deny this procedure . I agree it is a personal matter , but so is having all your limbs , being confined to a wheelchair , or needing counselling for post traumatic stress .

deertracker

Point taken but vets that are missing limbs, could be, as a direct result of being in the military, sex reassignment is unrelated.

jazzbo

Right.

Bluto

Possibly , but the real issue is whether the government has a legitimate excuse to deny the procedure even if it is an elective one . Other then simple closed mindedness I really can't find one . It isn't experimental , or illegal , so what other reasons would it have to say no to it ?

Stop It

I don't want my taxes to pay for it?

Bluto

I'm sure you don't want your taxes to pay for a lot of things , but they still do .

Nemesis

"but the real issue is whether the government has a legitimate excuse to deny the procedure even if it is an elective one"

Well, your first clue would be that word, elective. That Ferrari I need to drive in order to be comfortable is elective, too, and it's not experimental, or illegal.

Contango

Re: "The government should not be involved here at all."

"a federal board ruled Friday"

Well obviously other socialists disagree - Pay up!

Medicaid funding is the next stone to fall.

FORWARD SOVIET!

The Big Dog's back

So you are advocating to cut Medicaid pooh?

Contango

Re: "So (snip)"

Read the very first comment posted on this article, putz.

deertracker

Why do you keep going on about Medicaid? The ruling does not apply to Medicaid! READ!

Contango

Re: "The ruling does not apply to Medicaid!"

So why shouldn't it?

deertracker

Do you actually read your own posts?

Contango

Re: "Do you actually read your own posts?"

Yes, do you? :)

So as a bleeding heart lib, WHY shouldn't Medicare AND Medicaid pay for sexual readjustment surgery?

I

Perhaps, he/she should just give Lorena Bobbitt a call.

Stop It

LOL... That's only fifty percent of the job. Someone has to turn it inside out and stuff it up next to his other out hole.

be for real

IF they want to be different than what they were born as,then pay for it themselves this is plain stupid that tax payers money should have to pay for this,no wonder America is going broke

Dr. Information

Regardless of party affiliation you all have to agree that this is getting out of hand. Put down the D or R party button and look at what our tax dollars are now paying for.

This is insane.

SamAdams

There's a very big difference between getting injured on the job and getting injured on your own time. It's the same in the military as far as I'm concerned! If a soldier loses a limb or is otherwise injured while on duty, it's our obligation to pay for his/her treatment. On the other hand, if a female soldier wants larger breasts or a male soldier would like a hair transplant, it's NOT up to us to pay!

What about necessary medical care unrelated to the job? Say a soldier breaks his leg when he's roofing his garage, or she gets pregnant, for example. Shouldn't that be treated just the same way the REST of us are treated when the same thing happens to us?

Employment-related injuries should be covered by a separate insurance policy just like they are for everybody else. Other healthcare should be covered by health insurance whether it's through the VA or not, whether it's fully paid by the employer or not, and subject to the same limitations as any other job. Sorry, but this is elective surgery. There are all sorts of surgeries or other procedures that might make ME feel better, too, but I'm not asking anybody else to pay for it!