May 30, 2014
WASHINGTON – The U.S. Department of Health and Human Services (HHS) Departmental Appeals Board ruled today that Medicare’s categorical exclusion of coverage for sex-reassignment surgery, regardless of a person’s individual medical conditions and needs, is not consistent with contemporary science and medical standards of care.
The ACLU, Gay & Lesbian Advocates & Defenders (GLAD), and the National Center for Lesbian Rights (NCLR) have issued the following statement about the Board’s decision:
“This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare. 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.”
The HHS Departmental Appeals Board is an independent board within HHS staffed by career civil servants. The Board’s decisions constitute the final decision of HHS and are not subject to further review by political appointees.
The ACLU, GLAD, NCLR, and civil rights attorney Mary Lou Boelcke filed an administrative challenge last year on behalf of Denee Mallon, a transgender woman whose doctors have recommended surgery to alleviate her severe gender dysphoria.
Mallon joined the U.S. Army when she was 17-years-old and worked as a forensics investigator for a city police department after she was honorably discharged from the Army. She was later diagnosed with gender identity disorder (now known as gender dysphoria), a serious medical condition that is characterized by intense and persistent discomfort with one’s birth sex.