This article is more than 6 years old

This article is more than 6 years old

Transgender people receiving Medicare cannot be categorically denied coverage for sex-reassignment surgery, the Department of Health and Human Services (HHS) review board ruled on Friday, ending a decades-old ban.

Since 1981, such surgeries were excluded from procedures covered by Medicare, on grounds that they were still "experimental" and had a "high rate of serious complications".

"That coverage exclusion is no longer reasonable," the HHS departmental appeals board wrote in its decision on Friday.

An administrative challenge to the ban was launched on behalf of Denee Mallon, a Medicare recipient who was denied coverage for a sex reassignment surgery recommended by her physician.

A coalition of civil rights groups that included the American Civil Liberties Union (ACLU), Gay & Lesbian Advocates & Defenders (GLAD) and the National Center for Lesbian Rights (NCLR), as well as a civil rights lawyer, filed the challenge.

Mallon, a 74-year-old army veteran, applied for coverage two years ago after her doctors suggested she undergo genital reconstruction as treatment for gender dysphoria, a medical condition characterized by serious discomfort with one's biological sex.

"Sometimes I'm asked aren't I too old to have surgery. My answer is how old is too old?" Mallon told the Associated Press before the ruling.

"When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."



Advocates for the change are hailing the ruling as a significant win for transgender rights, because it recognizes the surgery as a medically effective treatment for people who do not identify with their birth sex.



The ACLU, GLAD and NCLR issued a joint statement: "This decision removes a threshold barrier to coverage for medical care for transgender people under Medicare."

The policy change does not mean that Medicare must pay for sex-reassignment surgeries, but it does enable officials to consider requests for coverage.

The groups' statement added: "They [transgender people] should either get coverage or, at a minimum, receive an individualized review of the medical need for the specific procedure they seek, just like anyone seeking coverage for any other medical treatment.”

The board said in its decision that the ruling does not extend to other treatment than sex reassignment surgeries.