Medicare will now cover transgender sex change surgery. The US Department of Health and Human Services (HHS) ruled that the agency recognizes the procedure is medically necessary for people who do not identify with their biological sex.
HHS ruled in favor of a 74-year-old Army veteran who wants Medicare to pay for transgender sex change surgery for genital reconstruction. The claim was denied two year ago. The Health and Human Services Appeals Board originally ruled that a 30-year-old decision excluding such procedures was unjustified.
Denee Mallon, the elderly New Mexico veteran who made the request, had this to say about the ruling:
“Sometime I am asked aren’t I too old to have surgery. My answer is how old is too old? When people ask if i am too old, it feels like they are implying that it’s a waste of money to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those year in congruence and not distress.”
Transgender Rights Project of Gay & Lesbian Advocate and Defenders lawyer Jennifer Levi said the HHS Medicare decision does not mean that all Medicare participants are “necessarily entitled” to a tax-payer funded sex change surgery. “They [patients] 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 of any other medical treatment,” Levi added.
The transgender sex reassignment surgery ruling does mean that Medicare recipients can now request authorization for the procedure. The formal request process would reportedly require submission of documentation from both a mental health professional and a physician stating that the sex change operation is “medically indicated” in each individual case.
Transgender health advocacy groups believe that private insurance companies often take their cue from Medicaid and state-run programs for low-income individuals when it comes to deciding what type of procedure to exclude or approve. The HHS sex change surgery ruling could open the door for sex change surgeries to become a commonly approved insurance benefit.
It is currently unknown if the Medicare transgender ruling in the Denee Mallon case will immediately impact another other sex change surgery denials or appeals. The William Institute, a LGBT think tank, estimates that.3 percent of the adult American population identifies as transgender.
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