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Gender surgery can be covered

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.

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, N.M., said in an e-mail 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 did not mean Medicare recipients were 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. More than 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.