HHS Reverses Ban On Medicare Coverage For Sex Re-Assignment Surgery

Chuck Ross Investigative Reporter
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Sex re-assignment surgeries can now be covered by Medicare, relaxing a ban that has stood in place since 1981, a Health and Human Services board has decided.

The Departmental Appeals Board, which works within HHS, issued the ruling Friday.

“The Board has determined that the National Coverage Determination (NCD) denying Medicare coverage of all transsexual surgery as a treatment for transsexualism is not valid under the reasonableness standard the Board applies,” reads the ruling.

A 1981 directive prevented the coverage of sex-reassignment surgeries banned their coverage by Medicare.

“Transsexual surgery for sex reassignment of transsexuals is controversial,” the three decade-old directive said. “Because of the lack of well controlled, long-term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental.”

But the appeals board found no grounds to enforce a “categorical exclusion” of the surgeries. The board cited research that has been conducted which claims that the surgeries should not be considered experimental or controversial.

“Since the NCD is no longer valid, its provisions are no longer a valid basis for denying claims for Medicare coverage of transsexual surgery,” the ruling reads, while noting that individual claims for the surgeries can be denied for other reasons permitted by law.

The ban was challenged last year by The National Center for Lesbian Rights and other groups that said the ban discriminates against transgender individuals, including people who suffer from a condition called gender dysphoria.

The groups said that the exclusion was not backed by science. The appeals board eventually heard the groups’ plea and weighed testimony from numerous experts.

Last year, the state of Oregon decided to provide coverage for the surgeries for state employees.

“The national policy barring Medicare from covering gender transition surgery has been invalidated by HHS’s Departmental Appeals Board,” said Aaron Albright, a spokesman for the Centers of Medicare and Medicaid Services, in a statement to The Daily Caller.

“As with all such determinations, CMS will carry out this independent board’s ruling through Medicare Administrative Contractors, who manage Medicare claims payment systems.”

“These contractors may cover this care case-by-case or under a local coverage determination based on clinical evidence to determine medical appropriateness,” Albright stated.

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