Quote:
Originally Posted by DapperButch
Medicaid is a state plan so I would suspect they would. Medicare is federal, so it would not be the case for them.
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Unfortunately, Dapper, I feel the need to disagree. The Medicaid Policy Writer, Medicaid Legislative Analyst and Program Manager side of me wants to help out in this situation ....Medicaid and Medicare are both Federal. The Feds (through the Centers for Medicare and Medicaid Services -CMS) tell the states what they can and cannot do with Medicaid policy and particular programs. When the Feds make a policy change, they publish it in the Federal Register...the states review the change and have the right to "comment" using the instructions published in the Register. .. There are two different ways that the Feds can direct the states to handle coverage: As a mandated item to add to the "State Medicaid Plan" or as an optional item that the state can decide if they want to cover it or not....THEN there's also the possibility of a "State Waiver" where a state can apply to CMS (the feds) for approval to cover something that's not written in "The State Plan" ...
My suggestion is for any advocate of gender reassignment surgery to be added to MEDICAID or MEDICARE, please write in hard copy to the management of Centers for Medicare and Medicaid Services in D.C...and also the Secretary of the federal Health and Human Services....in pleading any case for mandating coverage, it must be documented as "medically necessary".
Yes, there are Medicaid programs and services that are funded with Federal money and Medicaid programs/services/Waivers that are funded by state budget money. But the policy is driven from the feds down to the states...
if a procedure is currently NOT covered by Medicaid there are.certain legislative contacts to push it through.
I remember recently when dental care for adults has been drastically restricted because the feds and states reduced their budgets for items they decided to remove from the State Plans....
My worry is that even if Medical Necessity is proven for this surgery, several people at the federal or state level (ie. those against LGBTQ rights) will block any additions to the Medicaid or Medicare budget and policy.