On May 30, 2014, the Department Appeals Board at the Department of Health and Human Services issued a ruling that will end the discriminatory Medicare policy excluding transition-related surgeries from Medicare coverage. Transgender people receiving Medicare will no longer be automatically denied coverage for sex reassignment surgeries. The ruling recognizes the procedures as medically necessary for individuals who do not identify with their biological sex.
Like most other medical services under Medicare, patients must still be approved for any procedure by their provider(s). Decisions about coverage for transition-related care will be made on an individual basis. This ruling only affects Medicare. It will not affect private insurance, Medicaid, or Veterans insurance.
Although this change in Medicare will hopefully allow numerous people to finally transition, this ruling brings another issue to light. To qualify for transition-related surgery through private insurance or Medicare, a provider must diagnose a person with Gender Identity Disorder or Gender Dysphoria. These disorders are found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Providers use these codes to document a diagnosis, which in turn is used by insurance companies to determine reimbursement for care.
These diagnosis codes denote a disease or condition (a pathology). Thus, a Gender Identity Disorder / Gender Dysphoria diagnosis is double-edged. It is not only required for insurance companies to pay for transition-related health services, but it also shows that the person has a disease/disorder/condition. It pathologizes the individual.
In the meantime, it seems that this ruling will produce the most immediate results. Transgender people who qualify for Medicare will be able to seek transition-related health services. But more advocacy work needs to be done to de-pathologize transgender people, but still provide pathways for insurance companies to pay for their care.
Here are a few related web links:
National Center for Transgender Equality
American Psychiatric Association