Military Health Plan May Cover Some Transition-Related Care

A new rule proposed by the Department of Defense would require the military's healthcare provider, TriCare, to cover some transition-related care for service members and their dependents. The proposed rule would also expand access to mental health services for those covered under TriCare, reports the Military Times.

In a notice published in the Federal Register Monday, the Department of Defense suggested that TriCare "remove the categorical exclusion on treatment of gender dysphoria," clearing the way for transgender dependents of service members to access certain gender-affirming care under their existing health care plans.

The proposed rule has no impact on the military's longstanding ban on openly transgender Americans serving in uniform -- though a Pentagon working group tasked with dismantling that administrative policy is expected to release its recommendations for doing so sometime this spring.

If the proposed rule is adopted, TriCare would cover "all non-surgical medically necessary and appropriate care in the treatment of gender dysphoria," to include hormone therapy, psychotherapy, and pharmaceutical treatment.

Notably, the proposed rule still bars coverage of surgical treatment for trans and gender-nonconforming beneficiaries, meaning those seeking gender-affirming surgeries would still have to pay out of pocket for procedures that can easily cost upwards of $10,000.

Citing existing U.S. code regulating medical care for spouses and children of uniformed military members, the proposed rule implies that gender-confirming surgeries are "cosmetic," and therefore not medically necessary. This classification contradicts modern medical standards and best practices for treating transgender people, as the World Professional Association for Transgender Health has long deemed surgical care to be medically necessary for trans individuals seeking it.

Just last month, the U.S. Department of Health and Human Services made history when it determined, for the first time, that a transgender Air Force veteran's gender-affirming surgery must be covered under Medicare. The decision was viewed by trans advocates as one of the most definitive endorsements of those WPATH standards, coming on the heels of more than two dozen state insurance providers dropping categorical bans on transition-related care for trans individuals.

The proposed rule is intended to bring current TriCare practices into better accordance with the Mental Health Parity and Addiction Equity Act of 2008, and the Affordable Care Act, also known as "Obamacare," which included provisions intended to make it easier for trans Americans to obtain the healthcare they need, including surgical intervention.

While not all transgender people desire or pursue surgery, for many individuals, gender-affirming surgery is a critical part of bringing their outward presentation in line with their gender identity. This alignment can help alleviate symptoms of gender dysphoria, the clinical diagnosis used by the American Psychiatric Association that refers to feeling distress or discomfort at an incongruity between one's gender identity and one's sex assigned at birth.

"This is a modest but positive step forward in bringing DOD in line with current medical practice," Sue Fulton, president of LGBT military advocacy group SPARTA, tells The Advocate via email. "We owe it to our troops and their families to provide for their medical care, period, without political exceptions."

"All service members, veterans, and military dependents, no matter their gender identity, deserve access to the medical care they've earned serving our great nation," said American Military Partner Association president Ashley Broadway-Mack in a statement Monday. "This proposed rule change from the Department of Defense would be an incredibly important step in the right direction to help ensure our transgender service members, veterans, and family members finally receive the crucial medical care they need. As we await a decision from the Secretary of Defense on whether to lift the ban on transgender troops serving openly and honestly, this news is definitely encouraging."

"This is a significant step by the Pentagon to ensure that transgender service members, their families and veterans are being treated equal and have the ability to obtain the necessary care they deserve," said Matt Thorn, interim director of LGBT legal and advocacy group OutServe-SLDN in a statement Monday. "As we move closer to ending the ban on transgender service this announcement... is another part of the foundation in that quest. Ensuring that transgender service members and their families are able to seek and acquire adequate health care is fundamental and the Pentagon has recognized that."

The proposed rule would also lift annual limits on how many days a beneficiary can remain an inpatient at mental health facilities or residential treatment centers, and remove caps on lifetime care for substance abuse treatment and other chronic mental health conditions. The proposed rule will be open for public comment through April 1.