Older Americans who want to undergo sex change surgery may soon get coverage from Medicare as a federal board ruled on Friday that the federal health insurance program should no longer exclude coverage for the surgery.
The decision by the Departmental Appeals Board of the Department of Health and Human Services reverses a decades-old policy that excludes sex-reassignment surgery from Medicare coverage. The policy was put in place in 1981 when sex change surgeries were still considered as experimental.
The ruling that the 33-year-old Medicare ban on sex change surgeries is no longer reasonable was made on the basis that the procedure is already effective, safe and no longer experimental. The American Medical Association and the American Psychological Association, for instance, consider such surgeries as a safe option for individuals with gender dysphoria, formerly known as gender identity disorder (GID), a condition that psychologists and doctors diagnose for individuals who have significant discontent with their biological sex. Individuals with this condition experience great discomfort with their natural gender.
"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," the board said.
The board's decision likewise considered that the procedure is a medical necessity for some individuals who do not identify with the gender that they are born with, such as in the case of 74-year-old Denee Mallon, an Army veteran who was born a man but has been living as a woman.
The Friday's groundbreaking ruling was in response to a lawsuit filed by the Gay and Lesbian Advocates and Defenders (GLAD) in 2013 on behalf of Mallon, after her request from the Medicare to pay for her genital reconstruction two years ago was denied.
GLAD's Transgender Rights Project director Jennifer Levi, however, said that the ruling does not mean that everyone covered by Medicare can have a sex-reassignment surgery that will be taken care of by the government's funds. Individuals who intend to get coverage need to provide evidence from a doctor and mental health professionals that will prove the surgery is recommended.
"They should either get coverage or, at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment," GLAD, the American Civil Liberties Union (ACLU) and the National Center for Lesbian Rights (NCLR) said in a statement.
