The End of Medicare’s Ban on Sex Reassignment Surgeries: Providing Critical Health Care for Older Adults

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June 12, 2014

On Friday May 30, 2014, a U.S. Department of Health and Human Services (HHS) review board ruled that transgender people receiving Medicare may no longer be automatically denied coverage for sex reassignment surgeries. Prior to this ruling, Medicare, the federal government’s health insurance program for people over the age of 65 and people living with long-term disabilities, uniformly banned coverage of sex reassignment surgeries (SRS) for its nearly 50 million beneficiaries.

This ruling is a tremendous development for transgender seniors, many of whom rely solely on Medicare for health coverage. The end of a categorical exclusion on SRS coverage means that transgender seniors will now have access to the procedures that their doctors deem medically necessary for them without the constraints of a blanket rule preventing Medicare payments for those procedures across the board. This ruling affirms what the medical community has understood for many years --- that transgender people and their health care providers are best equipped to determine whether or not SRS is appropriate treatment in any individual instance. Removing this obstacle is particularly important in light of the disproportionate number of barriers experienced by transgender seniors to accessing health care in general.

Beyond its direct impact for Medicare recipients, this ruling also marks a broader victory for transition-related health care. Currently, very few insurance companies and employers, private or public, cover SRS in their health insurance plans despite both the medical consensus on the necessity of this care for transgender people and the data showing that insurance companies that do cover SRS are able to do so at minimal cost. Without insurance coverage, the costs of SRS for individual patients often cause transgender people to delay or forgo necessary healthcare. Putting off treatment of gender dysphoria, including SRS, has been shown to put a huge strain on our healthcare system, as well as on the individuals who require that care, as it leads transgender people to suffer various other mental and physical health problems. (See When Health Care Isn’t Caring: Transgender and Gender Non-Conforming People for more information about barriers to health care for transgender people). HHS’s ruling adds to the increasing recognition of the importance of individualized assessments of the health needs of transgender people, removing a discriminatory obstacle to equal and appropriate health care.

Lambda Legal congratulates our colleagues at GLAD, the ACLU, and NCLR for this decisive victory, and applauds this new decision as a positive step toward ensuring fair access to health care for transgender people in general, and particularly for the older members of the community.

For more information on issues affecting transgender older adults, click here and here.

Transgender Rights