The Associated Press reported today that a federal board has lifted the 30-year ban on Medicare coverage for sex reassignment surgery. The move comes among the recognition that doctors often deem such procedures medically necessary for people experiencing distress as a result of the gap between their sexual assignment at birth and their present gender identity. The condition is known as gender dysphoria.
Patients who have Medicare coverage and who seek sexual reassignment surgery will not necessarily be able to have the government pay for such services. Instead, they are now able to submit documents to Medicaid that their doctors endorse and that make a claim for the necessity of such surgeries. The AP mentions the expertise of Jennifer Levi, a lawyer with the Transgender Rights Project of Gay & Lesbian Advocates and Defenders who is located in Boston.
“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,” the AP reports, citing Levi.
The federal appeals board has lifted a 1981 ruling that said Medicare recipients were not eligible for what the ruling referred to as “transsexual surgery.” The procedure was, at the time, deemed to “controversial, experimental, and medically risky,” says the AP.
Regarding the ruling, the ACLU, Gay & Lesbian Advocates & Defenders (GLAD), and the National Center for Lesbian Rights (NCLR) issued a statement that contends the overturning of the ban aligns the law more directly with scientific research.
“This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare,” the groups said. “It is 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. 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. 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.”
Although the AP said there are no official figures for how many people the ruling will impact, it says approximately 0.3 percent of the U.S. population self-identifies as transgender. Additionally, it says, greater than 49 million American citizens have Medicare coverage.
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