Medicare and Transgender-Related Care
June 2014 | Aaron Tax, Director of Federal Relations, SAGE
On May 30, 2014, the Department of Health and Human Services (HHS) Department Appeals Board (DAB), an independent federal appeals board, ruled that Medicare must cover medically necessary care for individuals with gender dysphoria, just as it covers medically necessary care for those with other medical conditions.
In short, Medicare will now cover transition-related care for transgender older adults. Gay & Lesbian Advocates & Defenders (GLAD) the American Civil Liberties Union (ACLU), Lambda Legal, and the National Center for Lesbian Rights (NCLR) worked tirelessly on advocacy on this issue. This is an important milestone for transgender older adults, who after a lifetime of being denied medically necessary care, are finally on a level playing field with other Medicare recipients. Older transgender individuals are now able to get the comprehensive medical coverage they need and deserve.
The ability to access complete gender-transition related health care is essential to ensuring the health and well-being of transgender patients. The Medicare policy denying this care ran counter to decades of extensive scientific and clinical research, which supports surgically altering an individual's primary and secondary sex characteristics as a safe, effective and medically necessary treatment for severe gender dysphoria. This decision is lifesaving for many transgender individuals suffering from severe gender dysphoria. Both the medical and mental health professions have recognized that when denied proper medical care, individuals with gender dysphoria can develop severe psychological distress, dysfunction, and debilitating depression -- placing them at increased risk for suicide and self-harm.
Recognizing the dangers of denying proper medical care, the American Medical Association and the American Psychological Association have issued policy statements recognizing the medical necessity for gender transition-related treatments including hormone therapy and/or sex reassignment surgeries, as well as mental health care. For more information on this important change, the National Center for Transgender Equality has put together a comprehensive fact sheet on Medicare coverage of transition-related care.