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Medicare Ruling Big Win for Transgender Rights

No longer can program automatically deny requests to cover surgery
By Newser Editors and Wire Services
Posted May 30, 2014 2:31 PM CDT

(Newser) – Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled today in a groundbreaking decision that recognizes the procedures are medically necessary for people who don't identify with their biological sex. Ruling in favor of 74-year-old transgender Army veteran Denee Mallon of Albuquerque, whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency's Departmental Appeals Board said there was no justification for a three-decade-old HHS rule excluding such surgeries from procedures covered by the national health program for the elderly and disabled.

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Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government. Instead, 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, Levi said. (Read more transgender stories.)

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