Medicare’s blanket ban on sex-reassignment surgery is no more, a federal health board ruled Friday, in a watershed decision that reflects a growing understanding of gender dysphoria and the medical treatments necessary to alleviate it.
“The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition-related surgeries denied,” the ACLU, Gay & Lesbian Advocates & Defenders (GLAD,) and the National Center for Lesbian Rights (NCLR) said in a joint statement. “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.”
Friday’s decision from the U.S. Department of Health and Human Services (HHS) Departmental Appeals Board comes in response to an administrative challenge filed last year on behalf of a 74-year-old Army veteran. Denee Mallon, a transgender woman, applied for sex-reassignment surgery per her doctor’s recommendation, but was denied under Medicare’s terms -- now widely considered to be outdated.
"The problem was [the automatic barrier to surgery] was based on information from 1981,” said Leslie Cooper, an attorney with the American Civil Liberties Union, to msnbc. The ACLU brought the challenge to HHS along with GLAD, NCLR, and civil rights attorney Mary Lou Boelcke.
“As the decision of the board explained, the science has evolved significantly since 1981,” Cooper continued. “The scientific consensus among the medical community is that this treatment is medically necessary for people with gender dysphoria.”
Cooper did not have estimates on the number of Medicare recipients who would be affected by Friday’s decision, but pointed out that not all transgender people necessarily required surgery. “The standard of care is all about treatment plans based on the individual,” she said.
As for Mallon, she said she was “relieved” by the outcome.
“This decision means so much to me and many other transgender people,” said Mallon 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.”