SAN FRANCISCO — Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled Friday in a groundbreaking decision recognizing that 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 the disabled.
Jennifer Levi, a lawyer with the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling doesn't mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government. Instead, they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals saying surgery is recommended in their individual case, Levi said.
No statistics exist on how many people might be affected by the decision.