Medicare Asked to Reconsider Coverage of Sex Reassignment Surgery: APA Backs Public, Private Coverage of Transition Treatment
Ault, Alicia, Clinical Psychiatry News
Several organizations representing gay, lesbian, and transgender people have filed an administrative challenge seeking to overturn Medicare's 32-year-old prohibition on coverage of sex reassignment surgery.
"This administrative challenge is being considered and working its way through the proper administrative channels," a spokesman for the Centers for Medicare and Medicaid Services said.
The American Civil Liberties Union, Gay & Lesbian Advocates & Defenders, the National Center for Lesbian Rights, and civil rights attorney Mary Lou Boelcke filed the challenge on behalf of Denee Mallon, "a transgender woman whose doctors have recommended surgery to alleviate her severe gender dysphoria," according to a statement.
"Medicare's categorical exclusion of this care lacks any scientific basis," said NCLR legal director Shannon Minter, in the statement. "Study after study has shown that these surgeries are the only effective treatment for many patients suffering from severe gender dysphoria."
Joshua Block, a staff attorney with the ACLU Lesbian Gay Bisexual Transgender Project, noted that "the American Medical Association, the Endocrine Society, and the American Psychological Society all support these treatments for transgender patients." He added, "These procedures have been performed for decades and are proven to be safe and effective."
The AMA House of Delegates adopted a resolution in 2008 advocating private and public health insurance coverage for treatment of gender identity disorder, as recommended by a physician. The American Psychological Association's Council of Representatives adopted a policy statement the same year that, among other things, advocated adequate mental and physical health care for transgender and gender variant individuals. The Endocrine Society approved guidelines for transgender care in 2009.
In 2012, the American Psychiatric Association's Assembly approved a new policy backing public and private insurance coverage of gender transition treatment, and opposing exclusions for medically necessary treatment for transgender and gender variant people.
Kenneth Zucker, Ph.D., chair of the DSM-5 Workgroup on Sexual and Gender Identity Disorders, said in an interview that "there's considerable evidence that hormonal therapy and sex reassignment surgery is often the treatment of choice for adults with gender dysphoria who are carefully assessed." Dr. Zucker, psychologist in chief at the Centre for Addiction and Mental Health in Toronto, called that "beyond debate." The DSM-5, which is to be published this month, will include gender dysphoria as a diagnosis.
But Dr. Zucker said that a diagnosis does not dictate the best practice or treatment for any individual patient. He added that gender dysphoria had existed as a diagnosis since the DSM-III was published in 1980; however, it previously was known by other terms.
Surgical and other medical treatment of gender dysphoria has lagged in the United States primarily because of a lack of insurance coverage, Dr. …