The agency's Departmental Appeals Board lifted a three-decade-old ban on using Medicare funds for transsexual surgeries. The decision means the appeals board considers the surgeries as a necessary and effective medical treatment for some individuals who do not identify with their biological sex.
The appeals board noted the Centers for Medicare & Medicaid Service did not try to challenge its decision, which is final unless appealed in federal court.
The policy reversal came in response to a request from 74-year-old Army veteran Denee Mallon to have Medicare pay for genital reconstruction. Mallon, from Albuquerque, N.M., was born a man but has been diagnosed with "gender dysphoria," a state of distress about one's biological gender. Medicare had denied Mallon's request for surgery two years ago.
The Boston-based organization Gay & Lesbian Advocates & Defenders and American Civil Liberties Union helped Mallon file his appeal last year.
"Sometimes I am asked aren't I too old to have surgery," Mallon said before the board's decision. "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 years in congruence and not distress."
Gender reassignment surgeries vary by type and scope. For men, they can involve castration and genital reconstruction. For women, they can involve mastectomy and the implantation of a prosthetic. The cost of transsexual surgeries range from $7,000 to $50,000, according to the Transgender Law Center in Oakland, Calif.
The ruling means individuals on Medicare who can provide documentation from doctors and mental health professionals stating that a surgical sex change is medically indicated for them can bill the government for the procedure. The government-run Medicare program provides healthcare for 49 million Americans.
In explaining its decision, the appeals board said the ban on sex reassignment surgery had been based on medical evidence compiled in 1981 whereas new research showed the ban is "no longer reasonable." Rather, it called the surgery "safe" and an "effective treatment option."
Transgender advocates said the Medicare decision could influence private insurance companies and state-run Medicaid programs to also cover transsexual procedures since they often look to federal government policy as a guideline.
Although there are no reliable statistics to indicate how many people on Medicare could take advantage of the revised policy, demographer Gary Gates of The Williams Institute, an LGBT issues think tank in Los Angeles, has estimated 0.3 percent of the U.S. population identify as transgender.
Reported by WORLD News Service, an affiliate of World Magazine, on the Web at www.worldmag.com
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