Medicare beneficiaries who are transgender may now receive coverage for sex reassignment surgeries, a federal health board ruled Friday.
The decision lifts a decades-old ban on coverage for sex-change operations with Medicare and hands a major victory to transgender rights advocates who argued the rule was discriminatory.
The ruling means that individuals can petition Medicare to cover their sex-change operations using documentation from physicians and mental health professionals. It does not mean the program will automatically cover the procedures.
“The national policy barring Medicare from covering gender transition surgery has been invalidated by HHS’s Departmental Appeals Board. As with all such determinations, CMS will carry out this independent board’s ruling through Medicare Administrative Contractors, who manage Medicare claims payment systems," said Aaron Albright, spokesman for the Centers for Medicare and Medicaid Services. "These contractors may cover this care case-by-case or under a local coverage determination based on clinical evidence to determine medical appropriateness.”
Advocates hope the decision will place pressure on private health insurance companies and Medicaid programs to cover the surgeries as a matter of course.