Trans-Action Fees: Public Insurance, Medical Necessity, and Sex Reassignment Surgery

Abstract

Due to a general lack of understanding regarding transgender persons, this group of individuals is put at particular risk of discrimination in the area of law and medicine. The question of public insurance coverage for medical treatment of gender identity disorder is one of the most pressing issues in this field. This paper will provide an overview of transgenderism and treatments of gender identity disorder in order to assess the medical necessity of sex reassignment surgery and other procedures provided to transgender persons. While Medicaid guidelines do allow for the denial of medically necessary services, these denied services must fit certain criteria. Specific cases in which state insurance coverage was permitted or denied to transgender Medicaid patients will be examined in order to assess the overall ethicality of Medicaid policy towards transgender persons.