Gordon E B
Arch Sex Behav. 1991 Feb;20(1):61-74. doi: 10.1007/BF01543008.
Federal requirements for state Medicaid programs are surveyed, and case law regarding Medicaid funding of sex reassignment surgery is reviewed. States have attempted to exclude sex reassignment surgery (SRS) from Medicaid coverage on various bases, concluding, for example, that the procedure constituted "cosmetic surgery." Judicial scrutiny of such exclusions has usually resulted in the state action being found violative of the federal Medicaid statute and accompanying regulations. In those cases upholding the state exclusion, the primary judicial obstacle to funding has been a determination that SRS is "not medically necessary" or is "experimental." The author explores the recent scientific literature concerning long-term outcomes following SRS and concludes that the procedure, for purposes of Medicaid funding, is neither "unnecessary" nor "experimental," and that the categorical exclusion of SRS from Medicaid coverage is therefore inappropriate. The author recommends case-specific determinations of eligibility for Medicaid funding, utilizing the standards of care promulgated by The Harry Benjamin International Gender Dysphoria Association.
本文对联邦政府对各州医疗补助计划的要求进行了调查，并回顾了关于医疗补助为性别重置手术提供资金的判例法。各州曾试图以各种理由将性别重置手术（SRS）排除在医疗补助覆盖范围之外，例如认定该手术构成“整容手术”。对此类排除措施的司法审查通常导致州政府的行为被认定违反联邦医疗补助法规及相关规定。在那些维持州政府排除决定的案例中，为该手术提供资金的主要司法障碍在于认定SRS“并非医学必需”或“属于实验性手术”。作者探讨了近期关于性别重置手术后长期结果的科学文献，并得出结论，就医疗补助资金而言，该手术既非“不必要”也非“实验性”，因此将SRS完全排除在医疗补助覆盖范围之外是不合适的。作者建议根据具体案例，利用哈里·本杰明国际性别焦虑症协会颁布的护理标准来确定医疗补助资金的资格。
