Federal Board Overturns Medicare Exclusion of Transition-Related Care

AJ Trager

WASHINGTON, DC - The U.S. Department of Health and Human Services Department Appeals Board decided today that the exclusion of transition-related medical procedures in a 1989 Medicare policy did not reflect standards of care and is unreasonable and invalid based on today's science.

Like many other services under Medicare, decisions regarding transition-related care will now be decided on an individual basis. The ruling is final and cannot be appealed by the Center for Medicare and Medicaid Services.

This doesn't mean Medicare will cover all reassignment surgery, but instead eliminates the national rule that transition-related surgeries can never be covered, regardless of medical need. Nor can Medicare automatically deny individuals access to this coverage.

"Today's ruling represents the medical community's clear understanding that gender dysphoria is a serious medical condition, and the government should not stand in the way when doctors recommend treatment," Executive Director of the National Center for Transgender Equality (NCTE) Mara Keisling said in a statement following the ruling.

"This ruling comes from an independent panel who've studied the science on transgender healthcare. Today, this panel ruled that Medicare cannot flat-out exclude medically-supported treatments for transgender people," Keisling said. "Science and fairness are winning over outdated biases. NCTE will continue to advocate for access to medically necessary care for all transgender people."

Medicare adopted a National Coverage Determination categorically excluding "Transsexual Surgery" from coverage in 1989. Whereas other services in Medicare were determined on an individual basis, transition-related procedures were automatically denied. The adaptation disregarded a person's individual medical conditions and needs.

Executive Director of the National Gay and Lesbian Task Force, Rea Carey, came out in support of changing the policy.

"The dominos of discrimination against transgender people are falling rapidly. Today's ruling that transgender Medicare patients should have access to the medically necessary care their doctors prescribe, including transition-related surgeries, is a truly historic victory in the long struggle for full and equal access to medically necessary health care for transgender people. We know all too well the financial and social barriers transgender people experience in accessing the care they need, including a majority of transgender people being excluded from fully-inclusive medical coverage because of their gender identity," Carey said.

According to transequality.org, the ruling will neither affect private insurance plans nor Medicaid and applies only to Medicare. The NCTE expects to see more and more plans provide the medical care transgender people need. Major medical associations are already calling for the elimination of transgender exclusions in health plans.

For more information on the ruling visit the National Center for Transgender Equality's website at http://www.transequality.org/.
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