KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Medicare To Cover Sex-Change Surgery

The ruling, handed down Friday by a Department of Health and Human Services appeals board, reverses a Medicare policy in place since 1981. It covers surgery, but not other treatments like hormones.

The Washington Post: Ban Lifted On Medicare Coverage For Sex Change Surgery
The ruling by a Department of Health and Human Services board was in response to a lawsuit filed last year on behalf of Denee Mallon, 74, a transgender woman and army veteran from Albuquerque. The blanket Medicare ban was put in place in 1981 when such surgeries were considered experimental. But now most medical groups, including the American Medical Association and the American Psychological Association, consider it a safe option for those suffering from gender dysphoria, a condition that is characterized by intense discomfort — or “incongruence,” according to the official definition — with one’s birth sex (Cha, 5/30).

The New York Times: Medicare To Now Cover Sex-Change Surgery
The decision, handed down Friday by a Department of Health and Human Services appeals board, reverses a Medicare policy in place since 1981. It comes as a small but growing number of university health plans and large companies — including some Fortune 500 companies like Shell Oil and Campbell Soup — have started covering gender transition services, and could signal further changes since many health plans follow Medicare’s lead on coverage. ... The Medicare decision, which applies to beneficiaries of the health plan for older Americans and people with disabilities, covers only surgery, not other treatments like hormones (Rabin, 5/31).

The Wall Street Journal: Medicare Ban On Sex-Reassignment Surgery Lifted
Transgender people who receive Medicare benefits will no longer be automatically denied coverage for sex-reassignment surgery, a federal review board ruled Friday. The decision means that Medicare, the federal health insurance program for seniors and those with disabilities, will now cover sex-reassignment surgery on a case-by-case basis rather than routinely denying the surgery under guidance adopted during the 1980s (Armour, 5/30).

The Associated Press: Ruling Means Medicare Can Cover Transgender Surgical Procedures
Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled Friday in a groundbreaking decision that recognizes the procedures are medically necessary for people who don't identify with their biological sex. The Departmental Appeals Board ruled in favor of a 74-year-old transgender Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago. The board said there was no justification for a 3-decade-old Health and Human Services rule excluding such surgeries from procedures covered by the national health program for the elderly and disabled (Leff, 5/31).

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