On March 28, 2013, Centers for Medicare & Medicaid Services (CMS) announced a 30-day public comment period had been opened regarding Medicare's long standing ban on covering Sex Reassignment Surgeries for Transgender Americans. Just as proponents and opponents massed a comment campaign that threatened to flood the CMS servers, it disappeared. On March 29, approximately 5:00pm EST, the entire review and comments webpage was removed with all links ending at an error page. As with any sudden change there was widespread speculation on what happened. April 01, ACLU finally went public with the answer: Medicare had to stop the public comment period because a Transgender US Army veteran, backed by several national advocacy lawyers, filed an administrative challenge to Medicare's 32-year stance that these surgeries are experimental and elective.
"Medicare's categorical exclusion of this care lacks any scientific basis," said Shannon Minter, legal director at NCLR. "Study after study has shown that these surgeries are the only effective treatment for many patients suffering from severe gender dysphoria."
According to ACLU's press release:
The National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders, and civil rights attorney Mary Lou Boelcke initiated the challenge on behalf of Denee Mallon, a transgender woman whose doctors have recommended surgery to alleviate her severe gender dysphoria.
Denee Mallon served in the US Army and received an Honorable Discharge, thus is eligible for Veterans Health Services which provides Gender Identity counseling for eligible veterans. She then went on to work as a forensics investigator for a city police department, which provides exceptional private health insurance for employees and anyone who becomes disabled in service receives a compensation package that includes private health insurance. So far the only ailment spoken of is Ms. Mallon's suffering from severe Gender Identity Disorder, which does not qualify as a disabling condition by Medicare and Medicaid standards or by any other health service in America so it is still unknown why Ms. Mallon is specifically challenging Medicare.
There are many truly disabled Americans who are also Transgender, who live on low fixed income and have only Medicare and/or Medicaid for medical and behavioral health coverage. Several in the Knoxville area have received their hormone replacement therapy for years under Medicare's Part D, and had their counseling, blood tests, doctor appointments covered by Medicare Part B. Not being able to afford reassignment surgeries out of pocket and not being allowed coverage through Medicare has increased the need for behavioral health counseling and medical treatments due to the stresses of severe dysphoria. There is one verified case of TennCare (Medicaid in Tennessee) covering a sex reassignment surgery for a local Transman who began his medical transition in another state, however Tennessee natives are routinely denied coverage of any transitional medicine if the process is started while on TennCare.
Before the CMS review was closed some Knoxville residents, Transgender and non-Transgender, were able to get comments through. Rev Arteo MacAikenSneath of Celtic Circle Church was glad to offer his voice in support of Medicare providing SRS coverage, and he copied his comments to CMS onto the church's Facebook page:
American Medical Association has passed resolution stating that surgery to modify or change sex characteristics are medically necessary in the effective treatment of people with incongruity between sex anatomy and gender. Many studies have shown that the mental and physical health of Transgender/Transsexual patients improves drastically in relation to receiving medical transition services. Many person's needing gender transition surgeries are on Medicare as part of SSDI or SSI disability status. Being on SSDI or SSI means these individuals cannot afford paying for surgeries or even acquiring private insurance that will cover it. They deserve needed effective treatment of their GID just as they need treatment for whatever other medical conditions they have. In some cases the cost of surgery is offset by reduction in needed Behavioral Health treatments since the patient becomes more emotionally stabilized and invested in their continuing health. National Health Services in United Kingdom and Canada already provide full gender transition coverage including the best surgeries possible, even countries like Iran provide full sex reassignment surgeries for their eligible citizens. These procedures are medically necessary for health and safety, and will save Medicare a great deal of funds in the long run.
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