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Medicare's ban on sex-reassignment surgeries is over

Pedro Armestre / AFP via Getty Images

Medicare can no longer ban sex-reassignment surgeries, an independent board ruled Friday.

The ruling, in short, declared Medicare's ban scientifically outdated. When Medicare first imposed the ban in the 1980s, it reasoned, like many other health experts at the time, that transgender status was an untreatable mental health condition. Today, most of the health-care community, including the American Psychiatric Association, considers that view outdated: gender dysphoria can, depending on the patient, be successfully treated with hormone therapy and sex-reassignment surgery.

The board's decision, however, does not require Medicare to cover sex-reassignment surgeries, nor does it affect other government-run programs like Medicaid. It instead allows regional Medicare agencies and contractors to provide the procedure at their choosing.

LGBT advocates, prior to the decision, were fairly confident the board would rule in their favor. Advocates also suggested that the decision could influence private insurers and even Medicaid, since private insurers sometimes base their coverage decisions on the federal government's standards.

"Today's decision is a spectacular development," Amy Nelson, supervising attorney at Whitman-Walker Health's Legal Services Program, said in a statement. "Transgender and gender-variant people continue to face many barriers in seeking health services. Insurance coverage decisions should be consistent with science, and for far too long, that has not been the case. We hope this decision leads to the continued normalization of transgender health needs among insurers and medical providers."

Private health insurers, in response to questions about the looming decision, said that they base their coverage decisions on clinical evidence of safety and effectiveness of particular treatments for specific populations. Some private insurers already provided coverage for sex-reassignment surgeries, but not all.

The decision came through the Departmental Appeals Board, a board of experts that evaluates Medicare policies with a focus on science. The board is supposed to act independent of the US Department of Health and Human Services — and hopefully politics — when it issues decisions.