Medicare Ends Discriminatory Transgender Exclusions

Today Transgender Law Center celebrated the announcement of the final ruling by The U.S. Department of Health and Human Services (HHS) Departmental Appeals Board ending Medicare’s decades-long exclusion for coverage of certain types of health care treatment related to gender transition. This discriminatory rule barred transgender people from accessing health care they urgently need. Now that the blanket exclusion has been lifted, a transgender person who receives health coverage through Medicare can be individually evaluated by their primary health care provider. Treatments related to gender transition will be covered if determined to be medically necessary.

Medicare is the federal program that provides health insurance coverage for 48 million seniors and people with disabilities. Today’s decision from the Department of Health and Human Services’ Departmental Appeals Board is final and cannot be appealed.

“The medical consensus is clear that access to health care for gender transition is a critical medical need for many transgender people,” said Transgender Law Center Legal Director Ilona Turner. “Transgender people deserve the same access as everyone else to the medical treatment they need. We congratulate our colleagues at the ACLU, Gay & Lesbian Advocates & Defenders, and the National Center for Lesbian Rights for filing the challenge that led to this historic victory.”

Transgender Law Center submitted an amicus brief in support of the challenge, with the pro bono assistance of attorneys at WilmerHale.

The ruling follows administrative decisions issued by five states—California, Colorado, Connecticut, Oregon, and Vermont—and the District of Columbia that have all similarly concluded that across-the-board exclusions for transition-related care by private health plans are discriminatory and unlawful. California was the first such state to strike down those discriminatory exclusions, thanks to advocacy by Transgender Law Center and leadership from allies like California Insurance Commissioner Dave Jones.

The ruling is also in line with the clear consensus from all the leading medical organizations that hormone therapy and sex reassignment surgeries are safe, effective, non-experimental, and medically necessary treatment for gender dysphoria and, for some individuals, the only effective treatment. Those organizations include the American Medical Association, the Endocrine Society, the American Psychological Association, the American Academy of Family Physicians, and the World Professional Association for Transgender Health.

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