BREAKING NEWS: Medicare Exclusions for Transgender Care Lifted       

Denee Mallon, at the center of an appeals case for Medicare to consider coverage of transgender care – Craig Fritz, AP

Since the 1980s, Medicare has excluded transgender care from its plan, denying coverage to people with disabilities and elderly people needing this essential and life-affirming care regardless of medical necessity. This week, an appeals panel of the Department of Health and Human Services lifted the denial, opening the doors for transgender care. Congratulations and appreciation are sent deservingly to the National Center for Lesbian Rights, ACLU and Gay & Lesbian Advocates and Defenders for bringing about this important ruling.

The HHS report states, “Even assuming the [National Coverage Determination]’s exclusion of coverage at the time the NCO was adopted was reasonable, that coverage exclusion is no longer reasonable…This record includes expert medical testimony and studies published in the years after publication of the NCO.” It goes on to clarify, “Denying Medicare coverage of all transsexual surgery as a treatment for transsexualism is not valid under the ‘reasonableness standard’ the Board applies.”

This does not necessarily mean that all transgender-related care will be automatically covered by Medicare, but it does mean importantly that care related to transgender health needs will not be categorically denied for the millions covered under these plans. This is a permanent decision and will not be overturned.

This decision does not cover Medicaid, which is administered on a state by state basis and has varying levels of coverage for transgender health. This will also not cover Veteran’s health, which is governed differently. The other good news is that this decision may drive more private insurers to cover sex-reassignment surgeries and associated transgender care moving forward. President Obama has vowed to encourage health care research and clinical practice more supportive to the LGBT community, and this is one way that we can see this coming to fruition.

Interested in the details? Here’s the full ruling.

FEATURE PHOTO CREDIT: CRAIG FRITZ, AP