The United States Department of Health and Human Services (HHS) Departmental Appeals Board ruled on Friday that transgender people can no longer be automatically denied Medicare coverage for surgery as part of their transition-related health care.
The board ruled that the 33-year old blanket ban on coverage is unreasonable and based on biased standards. When the ban was instated in 1981, surgery was thought of as an “experimental” risk, but now it is considered safe and often medically necessary. Transgender people will now be eligible to receive coverage for surgery – which can include genital reconstruction, breast implants, mastectomies, vocal cord modification, and other procedures – or at least receive an individualized review of their circumstances instead of having their requests automatically denied. Because private health insurance companies and state Medicaid programs usually follow the federal government’s policies regarding coverage, advocates hope they will follow suit and expand their options.
The decision was made in response to an appeal by ACLU, GLAD, and NCLR on behalf of Denee Mallon, a 74-year-old transgender woman and veteran who was denied coverage for genital reconstruction surgery. “This decision means so much to me and to many other transgender people,” Mellon said in a statement. “I am relieved to know that my doctor and I can now address my medical needs, just as other patients and doctors do.”
The American Civil Liberties Union (ACLU), Gay and Lesbian Advocates and Defenders (GLAD), and National Center for Lesbian Rights in a joint statement called the decision “consistent with the consensus of the medical and scientific community that access to gender transition-related care is medically necessary for many people with gender dysphoria.”
Media Resources: ACLU 5/30/14; RH Reality Check 6/2/14; Huffington Post 5/30/14; ABC News 5/30/15
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