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to Section One | to Arts & Entertainment
posted Friday, June 6 2014 - Volume 42 Issue 23
Feds say Medicare must cover sex reassignment surgery - State Insurance Commissioner prepares to follow suit
Section One
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Feds say Medicare must cover sex reassignment surgery - State Insurance Commissioner prepares to follow suit

by Mike Andrew - SGN Staff Writer

The Obama administration ended a 33-year ban on Medicare funding sex reassignment surgery on May 31, when the Department of Health and Human Services (HHS) Departmental Appeals Board (DAB) ruled that excluding such surgery from coverage is 'no longer reasonable.'

Kara Klotz, spokesperson for Washington State Insurance Commissioner Mike Kreidler, told SGN that the Commissioner was preparing to bring statewide insurance coverage into line with the federal ruling.

'We are evaluating what our options are as far as notifying insurance carriers that they should cover [sex reassignment surgery],' Klotz said.

'The Commissioner believes it is an equality issue and a consumer issue we have to deal with.'

The Commissioner's office will issue a public statement 'soon,' Klotz said, 'hopefully this month.'

The Washington State Public Employees Benefits Board (PEBB) is also considering how to add coverage for the full range of transition-related services to healthcare plans offered to government workers by 2016.

The three insurance plans offered to public employees - the state-run Uniform Medical Plan, and the private Group Health and Kaiser Permanente - all cover mental healthcare related to gender identity issues. The two private plans also cover hormone therapy, but all of them exclude surgery.

The City of Seattle and King County already offer a full range of transition-related treatments to their employees, as do several private employers.

Oregon's Department of Consumer and Business Services ruled last year that transition-related medical services cannot be excluded from insurance plans offered in the state. California, Colorado, Vermont, Connecticut, and the District of Columbia have similar policies.

The Affordable Care Act also prohibits insurance discrimination against Transgender people.

Medically necessary procedures
Medicare considered sex reassignment surgery 'experimental' and refused to cover it for fear of 'serious complications' under the terms of policy guidelines formulated in 1981. DAB found that the old concerns were unfounded, however.

'Even assuming the [National Coverage Determination]'s exclusion of coverage at the time the [policy] was adopted was reasonable, that coverage exclusion is no longer reasonable,' reads the ruling. 'This record includes expert medical testimony and studies published in the years after publication of the [policy].'

'Denying Medicare coverage of all transsexual surgery as a treatment for transsexualism is not valid under the 'reasonableness standard' the Board applies,' the DAB ruling continues.

Under the new policy, Medicare will not automatically cover sex reassignment surgery and related care, but will no longer be prevented from doing so when claims are made, as HHS spokesperson Aaron Albright explained in a statement.

'The national policy barring Medicare from covering gender transition surgery has been invalidated by HHS's Departmental Appeals Board,' he said.

'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.'

In the 33 years since Medicare was barred from covering sex reassignment surgery, medical opinion has changed decisively. Such treatment is no longer labeled 'experimental,' but is now considered 'medically necessary.'

The American Medical Association, the American Psychiatric Association, the American Psychological Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the National Association of Social Workers, the American Public Health Association, and the American College of Obstetricians and Gynecologist have all endorsed the full range of transition-related health services.

Science and fairness are winning
Leading LGBT and human rights organizations applauded the HHS decision.

'This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare,' the ACLU, Gay and Lesbian Advocates and Defenders, and the National Center for Lesbian Rights said in a joint statement.

'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.'

'Today's ruling represents the medical community's clear understanding that gender dysphoria is a serious medical condition, and the government should not stand in the way when doctors recommend treatment,' National Center for Transgender Equality (NCTE) Executive Director Mara Keisling said in a May 31 statement.

'This ruling comes from an independent panel who've studied the science on transgender healthcare. Today, this panel ruled that Medicare cannot flat-out exclude medically-supported treatments for transgender people.'

Keisling added, 'Science and fairness are winning over outdated biases. NCTE will continue to advocate for access to medically necessary care for all transgender people.'

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