A staunch 74-year-old trans woman and Army veteran went toe to toe with Medicare over their denying her coverage of her sex reassignment surgery, and won. In a major decision today, the Department of Health and Human Services Appeals Board has invalidated a 30-year-old rule that excluded sex reassignment from procedures covered for the elderly and disabled under Medicare.
Denee Mallon, a veteran who lives in Albuquerque, was denied coverage for her surgery and she remembers saying to herself, "This is not right. They're relying on these archaic reasons to deny me the care my doctor agrees I need?" She vowed to fight the rule, and as she tells the AP:
"Sometimes I am asked aren't I too old to have surgery. My answer is how old is too old? 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."
In their decision, the appeals board wrote, "We have no difficulty concluding that the new evidence, which includes medical studies published in the more than 32 years since issuance of the [original rule], outweighs [previous evidence] and demonstrates that transsexual surgery is safe and effective and not experimental."
The decision could have wide implications both for Medicaid and for private insurers, who often take cues from the federal government regarding routine coverages.
As BuzzFeed reports, the HHS has already made a statement saying that they will carry out the board's ruling.