Yesterday, Medicare’s Departmental Appeals Board set aside a thirty-year-old National Coverage Determination excluding Medicare coverage for sex change surgery. As a result, Medicare beneficiaries may now seek coverage for sex change surgery, though the ruling does not make such coverage automatic; it only lifts the blanket national exclusion. Regional and case-by-case determinations that such surgery is not “medically necessary” could still apply. For news coverage, see here, here, and here.
The decision is not entirely surprising, Medicare had already in December reopened consideration of the National Coverage Determination precluding coverage. One question to watch is whether this decision, and the changed Medicare policy that ultimately results from it, winds up furthering the case for coverage in private insurance. There is an unmistakable trend in this area toward more coverage. Connecticut recently mandated coverage for many plans, and California and Oregon expanded coverage last year. And let’s not forget prison, in the First Circuit, at least, the refusal to provide sex change surgery to Michael Kosilek that doctors deemed to be medically necessary was ruled “cruel and unusual punishment.” (Coverage in the Globe here.)