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Veterans Health Administration Care for Transgender Veterans

May 17, 2019

The Veterans Health Administration (VHA) provides care for eligible veterans, including thousands of transgender veterans. VHA provides a wide range of health care services, including some transition-related medical care. However, VHA regulations still maintain an outdated and discriminatory exclusion for transition-related surgical care.

VHA has a policy calling for respectful delivery of healthcare to transgender and intersex veterans otherwise eligible for VA care.

Read on for more information on VHA’s Directive on care for transgender veterans, including on access to non-surgical transition-related care.

NCTE will continue to fight to remove VHA’s discriminatory exclusion of transition-related surgical care.

 

SUMMARY OF VHA CARE FOR TRANSGENDER VETERANS

Under current Veterans Health Administration policy:

  • All VHA staff are to provide care to transgender patients “in a manner that is consistent with their self-identified gender identity.” This includes:
    • VHA staff and providers are required to refer to transgender veterans using their requested name and pronouns, even if the person has not updated their government-issued identification
    • Transgender veterans should be able to access VHA facilities, including restrooms, according to their gender identity
  • VHA staff are required to keep all personal information about transgender status and medical care confidential;
  • Under existing VHA regulations, transition-related surgical care cannot be performed or paid for by the VHA regardless of medically necessity;
  • All other medically necessary health care for transgender veterans is covered, including care typically considered “sex specific,” such as mammograms and Pap smears, as well as transition-related care such as hormone replacement therapy, medically necessary prosthetics (such as binders and dilators), voice coaching, and mental health services.

 

QUESTIONS AND ANSWERS ON VHA CARE

 

What about Active Duty military, Retired military, or military dependents?
Health care for active duty service and retired service members and military dependents is provided through the TRICARE program, run by the Department of Defense. This program is completely separate from the Veterans Health Administration or the Department of Veterans Affairs, and therefore is not subject to direct influence by VA policies. The transgender service ban implemented by the Trump Administration on April 12, 2019 does not apply to medical care for eligible military retirees or dependents. Current TRICARE regulations permit medically necessary mental health care and hormone therapy for eligible dependents but arbitrarily ban surgical care regardless of medical need.

The CHAMPVA program for certain dependents of veterans, is operated by a separate department within the Department of Veterans Affairs and subject to a different set of regulations. An outdated provision still in CHAMPVA’s regulations states, “services or supplies related to transsexualism” are barred from coverage (38 CFR § 17.272). 

NCTE will continue to work with policymakers to amend these regulations and provide full medical coverage to transgender military personnel and dependents in both the CHAMPVA and TRICARE programs.

For more information for Active Duty members and the military ban, check out this resource.

 

What medical services and supplies will VA cover?
With one glaring exception, veterans eligible for VA care may receive all medically necessary care. This includes hormone therapy, mental health care, preoperative evaluation, post-operative long-term care, medically necessary prosthetics (such as binders and dilators), voice coaching, and any routine health screenings (such as breast, prostate, or cervical cancer screenings). The single exception is transition-related surgery, which is prohibit by VA regulations regardless of medical need.

 

Transition-related surgery can mean many things. What does VHA mean when they say they won’t cover it?
The Directive defines transition-related surgery surgery as:

any of a variety of surgical procedures (including but not limited to vaginoplasty and breast augmentation in transgender women and mastectomy and phalloplasty in transgender men) done simultaneously or sequentially with the explicit goal of gender transitioning.”

Transition-related surgery only includes surgical procedures such as those listed above and does not include other treatments described elsewhere in the Directive (e.g., hormone therapy, mental health care).

In short, this means that the existing surgery exclusion applies only to actual surgical procedures, and does not bar VA facilities from providing pre- or post-operative evaluations or care. If you have had surgery outside the VA system and need follow-up care or post-operative care, and are eligible for VA benefits, your care will be provided at a VA facility. Similarly, if you are planning on having surgery outside the VHA system and require pre-operative evaluation, VA facilities will provide that care as well. The only thing VHA will not do is perform or pay for transition-related surgical procedures.

Note that in the case of transgender veterans for whom hormone-replacement therapy is ineffective or cannot be tolerated by a patient and there are no other “standard medical options for hormone management,” VHA may provide an orchiectomy as part of hormone management. For more information, check out Appendix A of the VHA Directive.

 

Will hormones or other transition-related care cost me any extra when I go to a VA facility?
The costs for transition-related health care and prescriptions will be exactly the same as they would be for any other health care and prescriptions. In all VA facilities, veterans are classified based on the degree of service-related disability they have received, and are charged for medical services, mental health services, and medication based on their classification. For some veterans, some costs would apply, such as $50 co-pays for mental health care visits, $15 co-pays for primary care physician visits, and $8 for a one-month supply of each prescription. For other veterans, all health care and prescriptions are covered. Your health care, whether it is hormone replacement therapy, mental health care services, pre- or post-operative evaluations, prosthetics, or any other transition-related care, would cost you based on your disability classification, and you would see no cost increase due to the nature of the care.

 

What about my privacy? I’ve had trouble with privacy at my VA facility.
This Directive very clearly states that all medical and administrative staff will treat any information about a person’s transition-related treatment or transgender status as confidential unless relevant to medical care or when the patient gives permission to share this information. The Directive also indicates that all VA staff are to provide care to transgender patients “without discrimination in a manner consistent with care and management of all Veterans.”

 

Does the VA policy affect my medical records?
Yes. VHA’s medical records have a “birth sex” field and a “self-identified gender identity” (SIGI) field. The SIGI field will reflect an individual’s self-identified gender. In order to change the name and gender in VA medical records, the individual must make an request to the facility’s Master Veteran Index Coordinator (often the Privacy Officer), and submit official documentation of the change in name or sex. For a full list of documents needed, refer to VHA’s Identity Management Fact Sheet.

 

Who can I contact if I have problems accessing the medical care that I need?
If you need assistance accessing healthcare or need to have an issue resolved, you should talk to the Patient Advocate at your local VA Medical Center. In addition to the new Directive that applies to transgender and intersex veterans, there is a patient’s “bill of rights” that applies to every veteran. It can be accessed here: http://www.patientadvocate.va.gov/Rights.asp.

 

ADDITIONAL RESOURCES

The Transgender Healthcare Directive is available to read on the VHA Website.

VHA also has a specific page with resources for LGBT veterans

Several resources are available to all veterans:

Transgender veterans may reach out to:

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