Medicare could pay for sex-change surgeries under decision by federal board

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(CNN) — The decision on whether Medicare pays for sex-change operations is now in the hands of regional administrators, thanks to a decision Friday by a federal board that overturned a national policy of not covering such surgeries.

The ruling by the Departmental Appeals Board of the Department of Health and Human Services gives authority to 15 regional contractors who administer the Medicare program to decide whether sex-change surgeries will be covered in their territories.

“The national policy barring Medicare from covering gender transition surgery has been invalidated,” said Centers for Medicare and Medicaid Services spokesman Aaron Albright in an e-mail to CNN.

“As with all such determinations, CMS will carry out this independent board’s ruling through Medicare Administrative Contractors, who manage Medicare claims payment systems. These contractors may cover this care case-by-case or under a local coverage determination based on clinical evidence to determine medical appropriateness,” added Albright, whose agency administers Medicare and Medicaid.

The American Civil Liberties Union (ACLU), Gay & Lesbian Advocates & Defenders (GLAD), and the National Center for Lesbian Rights (NCLR) responded with a joint statement praising the move:

“This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare. It is consistent with the consensus of the medical and scientific community that access to gender transition-related care is medically necessary for many people with gender dysphoria,” the statement said.

“The removal of the exclusion of coverage for surgical care for Medicare recipients means that individuals will not automatically have claims of coverage for gender transition-related surgeries denied. They 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 for any other medical treatment.”

The National Gay and Lesbian Task Force issued a statement that concluded, “The dominoes are falling rapidly.”