A transgender man, who is a Medicaid-eligible resident of Delaware County, Pennsylvania, has filed a lawsuit against the PA Department of Human Services Secretary, Theodore Dallas. The lawsuit, filed under the pseudonym “John Doe,” claims that the denial of Doe’s request for a hysterectomy to treat gender dysphoria (“GD”) constitutes a violation of civil rights, citing “The Medicaid Act mandates that a state plan provide for making medical assistance available to all categorically needy individuals by providing, at minimum, medically necessary physician, hospital and other services, and also provide, at a minimum, payments for such services…”The lawsuit also specifies “Medically necessary procedures for GD Treatment may include hormone or other prescriptions, therapy, Gender Confirmation Surgery (“GCS” or “bottom surgery”), breast implants or removal (“top surgery”), and others, including hysterectomy, genital reconstruction, and plastic surgery, as appropriate and prescribed and medically necessary for the particular person.”Although gender reassignment surgeries have not been covered by Medicaid historically, the federal Department of Health and Human Services lifted the official ban on coverage of these treatments in May 2014.Doe’s lawsuit seeks not only compensatory and punitive damages and Medicaid coverage of treatment for Doe’s GD, but also asks the judge to end the state’s ban on covering treatment for GD for other Medicaid-eligible individuals. Transgender man sues state to pay for hysterectomy – The Morning Call 1-1 1-2 1-3 1-4 1-main
Frank Cummins is a Man with gender dysphoria. He claimed that he was denied Social Security Disability and Supplemental Security Income benefits because the administrative law judge discriminated against him due to his transgender status. A federal court rejected that claim, but reversed on other grounds.
Jacob Curry is a Man who identifies as a Woman. He asserted entitlement to Social Security Disability benefits and Supplemental Security income based on his gender dysphoria. A court rejected his claim that gender dysphoria rendered him unable to work, but remanded his claim for benefits on other grounds. Curry is one of many litigants seeking such benefits for gender dysphoria.
Claims that New York state’s new policy on Medicaid funding for sex reassignment surgery falls short because it doesn’t cover cosmetic procedures such as breast augmentation and voice therapy will go forward following a judge’s order. Southern District Judge Jed Rakoff refused to dismiss three claims based on refusal to fully fund the treatment of gender identity disorder or gender dysphoria under the Medicaid program, 14 U.S.C. Section 1396, including refusing surgery for those under 18.
Rakoff also dealt with an issue under the Affordable Care Act, refusing to dismiss a sex-based discrimination claim that says people should be able to pursue cosmetic surgery if it is deemed medically necessary. However he also granted the state’s motion to dismiss on a claim under the act for youth hormone therapy for those under 18.
Verna Pinneke began life as a male, but quickly became uncomfortable with the male “gender identity.” After extensive testing, doctors concluded that she had a transsexual personality, and required sex reassignment surgery. She underwent sex reassignment surgery on April 20, 1976. As a Supplemental Security Income recipient, Pinneke was eligible for benefits under the Medicaid program, 42 U.S.C. § 1396 (1976). She applied for funding of her sex reassignment surgery under the Medicaid program, but the Cerro Gordo County office of the Iowa Department of Social Services refused funding. The Commissioner of the Iowa Department of Social Services affirmed this decision on the basis that the State of Iowa’s Medicaid plan specifically excludes coverage for sex reassignment surgery. Pinneke then filed a lawsuit seeking remedial injunctive and declaratory relief from the denial of her constitutional rights to equal protection and due process and her statutory right to Medicaid benefits. The trial court found the surgery was “the only medical treatment available” to address his transgender status and the U.S. Court of Appeals for the 8th Circuit affirmed.
Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled 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 , Denee Mallon, 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. Medicare ban on sex reassignment surgery lifted.
Massachusetts is the third state in the nation to cover transgender medical services, including gender reassignment surgery, as a standard benefit in its government health plan for lower-income and disabled people. The administration of Governor Deval Patrick also moved to prohibit private insurers from denying coverage for gender reassignment surgery or other treatments medically necessary for patients who are transgender, saying that would constitute sex discrimination.
The Patrick administration will strongly recommend similar reforms to the Group Insurance Commission, which provides coverage for thousands of state and municipal employees and their dependents. Only two other states — California and Vermont — have Medicaid programs guaranteeing treatment for gender dysphoria, a mental illness in which there is a pronounced difference between patients’ feelings about their gender and their physical sex characteristics. People with gender dysphoria identify with stereotypes about the opposite sex. Boston councilors to press for insurance coverage for city workers seeking gender reassignment surgery – Metro – The Boston Globe. State to cover gender reassignment surgery and hormone treatment for transgender patients – Metro – The Boston Globe.