Wednesday, August 27, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Medicare ban on sex reassignment surgery lifted

By
From page A5 | May 31, 2014 |

SAN FRANCISCO — Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled Friday in a groundbreaking decision that recognizes the procedures are medically necessary for some people who don’t identify with their biological sex.

Ruling in favor of a 74-year-old transgender Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, a U.S. Department of Health and Human Services review board said there was no justification for a three-decade-old agency rule excluding such surgeries from treatments covered by the national health program for the elderly and disabled.

“Sometimes I am asked aren’t I too old to have surgery. My answer is how old is too old?” the veteran, Denee Mallon, of Albuquerque, New Mexico, said in an email interview before the board issued its decision. “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.”

Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government.

Instead, the lifting of the coverage ban means they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals stating that surgery is recommended in their individual case, Levi said.

No statistics exist on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at the University of California, Los Angeles, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.

The cost of gender reassignment surgery varies, but typically ranges from $7,000 to $50,000, according to the Transgender Law Center in Oakland, California.

In Friday’s ruling, the appeals board said that HHS lacked sufficient evidence in 1981 when it made a “national coverage determination,” or NCD, holding that Medicare recipients were ineligible for what it then called “transsexual surgery” because the procedure was too controversial, experimental and medically risky.

The panel went on to say that regardless of what the record showed then, studies and experts have since shown the efficacy of surgical interventions as a treatment for gender dysphoria, the diagnosis given to people who experience extreme distress due to the disconnect between their birth sex and their gender identity.

“We have no difficulty concluding that the new evidence, which includes medical studies published in the more than 32 years since issuance of the 1981 report underlying the NCD, outweighs the NCD record and demonstrates that transsexual surgery is safe and effective and not experimental. Thus, as we discuss below, the grounds for the …exclusion of coverage are not reasonable,” the civilian panel said.

The appeals board’s decisions are binding on HHS unless they are appealed in federal court. The Centers for Medicare and Medicaid Services, the agency within HHS that manages Medicare, opted not to defend the transgender surgery exclusion before the five-member board and had initiated the process for lifting it on its own before Mallon filed her complaint.

The ruling does not apply to Medicaid, which provides health coverage for individuals and families with low-incomes and is regulated by the states. Some states have exclusions on sex reassignment surgeries and the sex hormones transgender people often take during their transitions, while others evaluate claims on a case-by-case basis.

Transgender health advocates said that because private insurance companies and Medicaid programs often take their cues from the federal government on what is considered medically necessary, elective or experimental, the decision could pave the way for sex-reassignment surgeries to be a routinely covered benefit.

Mallon was born a man and has lived as a woman on and off since she was a teenager and full time since 2009. The Centers for Medicare and Medicaid Services must eliminate its blanket exclusion on transition-related surgeries within 30 days and re-evaluate Mallon’s medical claim in light of the change, the HHS board said.

“This decision means so much to me and to many other transgender people. I am relieved to know that my doctor and I can now address my medical needs, just as other patients and doctors do,” Mallon said in a statement Friday.

The Associated Press

The Associated Press

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

Walnut Grove: Fun facts, things to see

By Susan Winlow | From Page: A1

 
Ryde Hotel: A speakeasy from the past

By Susan Winlow | From Page: A1, 1 Comment | Gallery

Walnut Grove shows a bit of historic Japan

By Susan Winlow | From Page: A1 | Gallery

 
Solano County supervisors get raise

By Barry Eberling | From Page: A2, 3 Comments

Solano helps after Napa quake

By Barry Eberling | From Page: A3 | Gallery

 
Weather for Aug. 27, 2014

By Daily Republic | From Page: B3

Solano supervisors declare quake state of emergency

By Barry Eberling | From Page: A3

 
 
Solano promotes hand washing

By Barry Eberling | From Page: A5, 2 Comments

 
Golf tournament to benefit college sport’s teams

By Susan Winlow | From Page: A6

 
Man steals car from Fairfield resident

By Barry Eberling | From Page: A6, 6 Comments

 
Learn about local travel opportunities

By Amy Maginnis-Honey | From Page: A6

Solano College to host college transfer fair

By Susan Winlow | From Page: A6

 
Pierce Brosnan thriller kicks off week’s new films

By Amy Maginnis-Honey | From Page: A7

 
Museum guild schedules trip to historic San Francisco home

By Amy Maginnis-Honey | From Page: A8

 
 
3 die in I-680 crash; 2 from Vacaville

By Ian Thompson | From Page: A9

 
Fairfield police log: Aug. 24, 2014

By Glen Faison | From Page: A12

 
Fairfield police log: Aug. 23, 2014

By Glen Faison | From Page: A12

Suisun City police log: Aug. 24, 2014

By Glen Faison | From Page: A12

 
Suisun City police log: Aug. 23, 2014

By Glen Faison | From Page: A12

Fairfield police log: Aug. 25, 2014

By Susan Hiland | From Page: A12

 
Suisun City police log: Aug. 25, 2014

By Glen Faison | From Page: A12

.

US / World

Napa quake stirs clamor for warning system

By The Associated Press | From Page: B8

 
American woman held hostage in Syria

By The Associated Press | From Page: B8

Putin and Poroshenko meet for bilateral talks

By The Associated Press | From Page: B8, 1 Comment

 
Group files petition to idle coastal nuke plant

By The Associated Press | From Page: B8

Israel, Hamas agree to open-ended Gaza cease-fire

By The Associated Press | From Page: B8, 1 Comment

 
Los Angeles schools halt iPad deal amid criticism

By The Associated Press | From Page: B8

Report finds 1,400 children exploited in UK town

By The Associated Press | From Page: B8, 1 Comment

 
Police: Slain woman ID’d ex-deputy as her attacker

By The Associated Press | From Page: B8

Officials: Instructor accidentally killed by girl

By The Associated Press | From Page: B8, 5 Comments

 
Judges blast Indiana, Wisconsin gay marriage bans

By The Associated Press | From Page: B8

UN panel: Global warming human-caused, dangerous

By The Associated Press | From Page: B8

 
Obama defends handling of veterans affairs issues

By The Associated Press | From Page: B8, 2 Comments

Arab strikes in Libya show impatience with US

By The Associated Press | From Page: B8, 1 Comment

 
AP sources: US surveillance planes fly over Syria

By The Associated Press | From Page: B8, 2 Comments

.

Opinion

Abandoned carts are everyone’s responsibility

By Letter to the Editor | From Page: A11, 8 Comments

 
Editorial cartoons for Aug. 27, 2014

By Daily Republic Syndicated Content | From Page: A11

Question of the week: Is US policy on hostages correct?

By Daily Republic | From Page: A11

 
Obama risks alienating Latinos from Dems

By Thomas Elias | From Page: A11

 
How to reduce taxes without busting the budget

By Ramesh Ponnuru | From Page: A11

.

Living

Today in History: Aug. 27, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Aug. 27, 2014

By Susan Hiland | From Page: A2

We were good parents. Why won’t our adult children help us out?

By Kathy Mitchell and Marcy Sugar | From Page: B6

 
Horoscopes: Aug. 27, 2014

By Holiday Mathis | From Page: B6

Choosing chutney

By Mcclatchy-Tribune News Service | From Page: B7

 
Banishing the blues with healthy blueberry muffins

By Sara Moulton | From Page: B7

.

Entertainment

TVGrid

By Daily Republic Syndicated Content | From Page: A7

 
Women talk about sports on CBS Sports Network

By The Associated Press | From Page: A7

Miley Cyrus’ date wanted by Oregon police

By The Associated Press | From Page: A7

 
NBC’s Emmycast logs robust 15.6 million viewership

By The Associated Press | From Page: A7

.

Sports

Prep football preview: Indians positive heading into 2014 season

By Paul Farmer | From Page: B1 | Gallery

 
Serena Williams beats American teen at US Open

By The Associated Press | From Page: B1

Carter’s HR in 8th leads Astros over A’s 4-2

By The Associated Press | From Page: B1 | Gallery

 
US teen Bellis, 15, stuns Cibulkova at US Open

By The Associated Press | From Page: B1

Raiders CB DJ Hayden to start season on PUP list

By The Associated Press | From Page: B1

 
49ers prepare for possible Aldon Smith suspension

By The Associated Press | From Page: B1

Bumgarner flirts with perfection, finishes with 1-hitter in Giants win

By The Associated Press | From Page: B2 | Gallery

 
No reason to feel sorry for Jim Furyk

By The Associated Press | From Page: B2

TMS 2015 schedule springs back to night race

By The Associated Press | From Page: B2

 
Love struck: Kevin Love pledges commitment to Cavs

By The Associated Press | From Page: B2

Sarkisian: USC looking into Shaw’s heroic story

By The Associated Press | From Page: B2

 
Davis, US men beat Slovenia in basketball exhibition

By The Associated Press | From Page: B2

Latest Astrodome proposal: massive indoor park

By The Associated Press | From Page: B2

 
.

Business

UN health agency urges crackdown on e-cigarettes

By The Associated Press | From Page: B8

 
Survey: US consumer confidence near a 7-year high

By The Associated Press | From Page: B8

Burger King buys, plans expansion of Tim Hortons

By The Associated Press | From Page: B8

 
.

Obituaries

Nadine L Wetherell

By Susan Hiland | From Page: A4

 
Frank W. Moy Jr.

By Nancy Green | From Page: A4

Lyle Cullum

By Nancy Green | From Page: A4, 1 Comment

 
Gary Allen Person

By Nancy Green | From Page: A4

Florentino”Paul” Castaneda Bersola

By Susan Hiland | From Page: A4

 
.

Comics

Baldo

By Daily Republic Syndicated Content | From Page: B5

 
Blondie

By Daily Republic Syndicated Content | From Page: B5

Beetle Bailey

By Daily Republic Syndicated Content | From Page: B5

 
Peanuts

By Daily Republic Syndicated Content | From Page: B5

Baby Blues

By Daily Republic Syndicated Content | From Page: B5

 
Frank and Ernest

By Daily Republic Syndicated Content | From Page: B5

Zits

By Daily Republic Syndicated Content | From Page: B5

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: B5

B.C.

By Daily Republic Syndicated Content | From Page: B5

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: B5

Sally Forth

By Daily Republic Syndicated Content | From Page: B5

 
Garfield

By Daily Republic Syndicated Content | From Page: B5

Dilbert

By Daily Republic Syndicated Content | From Page: B5

 
For Better or Worse

By Daily Republic Syndicated Content | From Page: B5

Pickles

By Daily Republic Syndicated Content | From Page: B5

 
Get Fuzzy

By Daily Republic Syndicated Content | From Page: B5

Crossword

By Daily Republic Syndicated Content | From Page: B6

 
Word Sleuth

By Daily Republic Syndicated Content | From Page: B6

Cryptoquote

By Daily Republic Syndicated Content | From Page: B6

 
Bridge

By Daily Republic Syndicated Content | From Page: B6

Sudoku

By Daily Republic Syndicated Content | From Page: B6