SAN FRANCISCO — 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 some people who don’t identify with their biological sex.
Ruling 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, a U.S. Department of Health and Human Services review board said there was no justification for a three-decade-old agency rule excluding such surgeries from treatments covered by the national health program for the elderly and disabled.
“Sometimes I am asked aren’t I too old to have surgery. My answer is how old is too old?” the veteran, Denee Mallon, of Albuquerque, New Mexico, said in an email interview before the board issued its decision. “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.”
Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government.
Instead, the lifting of the coverage ban means they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals stating that surgery is recommended in their individual case, Levi said.
No statistics exist on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at the University of California, Los Angeles, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.