Does Medicaid Cover Gender Reassignment Surgery

Since 2014 medicare has covered medically necessary sex reassignment surgery with coverage decisions made on a case by case basis depending on medical need. Now medicare extends coverage to gender reassignment or gender confirmation surgeries on a case by case basis this is the same standard medicare uses for many other treatments and procedures.

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The guidance was updated most recently in march 2019 to provide for coverage of gender affirmation surgery intended to refine.

Does Medicaid Cover Gender Reassignment Surgery. A person can appeal the decision if surgery is denied. As of may 2014 the 33 year exclusion on medicare coverage of gender reassignment surgery was lifted. Many health plans are still using exclusions such as services related to sex change or sex reassignment surgery to deny coverage to transgender people for certain health care services.

In accordance with the revised regulations medicaid ffs and mmc plans will provide reimbursement for medically necessary hormone therapy for treatment of gender dysphoria. Hormone therapy whether or not in preparation for gender reassignment surgery will be covered as follows. However gender reassignment surgeries were considered experimental and were banned by medicare in 1981.

Effective august 30 2016 after examining the medical evidence cms determined that no national coverage determination ncd is appropriate at this time for gender reassignment surgery for medicare. The department of veterans affairs va has also proposed eliminating its long standing ban on paying for sex reassignment surgery for america s veterans. 19 gender reassignment codes 54400 through 54417 and 19318 may be.

Previously medicare didn t cover gender reassignment surgery because a sex change was thought an experimental procedure. Now medicare administrative contractors determine coverage of gender reassignment surgery on an individual claim basis. The centers for medicare medicaid coverage cms conducted a national coverage analysis that focused on the topic of gender reassignment surgery.

Or report the issue to the centers for medicare medicaid services by email to marketconduct cms hhs gov. Or burdens for transgender people seeking care. Medicaid coverage of pubertal suppressants and cross sex hormones.

State medicaid policy explicitly covers transition related health care see medical assistance bulletin 99 16 11 2016. Medicare provides coverage for gender reassignment surgery although it needs to be deemed as medically necessary. Coverage varies by state.

Rhode island state medicaid policy explicitly covers transition related health care see gender dysphoria gender nonconformity coverage guidelines 2015. That medicaid covers gender affirming care 9 the guidance has been updated and expanded.

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