New hope for gender-affirming surgery funding on Medicare

Australian Medicare card against a transgender pride flag background
Images: Supplied

The Health Department will next month consider an application to subsidise gender-affirming surgeries under Medicare in a major push to cut costs and improve access for transgender Australians.

In 2021, over 148,000 people signed a petition calling for public funding of gender-affirming surgery.

The petition explained for some people, the procedures are essential for their mental health and wellbeing. However, high out-of-pocket costs without Medicare subsidies put the care out of reach of many who need it.

At the time, then-health minister Greg Hunt responded by saying a specific application was needed to list procedures on the Medicare Benefits Schedule.

In December, the Medical Services Advisory Committee (MSAC) will consider such an application for the first time.

The application is from the Australian Society of Plastic Surgeons (ASPS). The peak body says it “directly addresses the gap identified by then-Minister Hunt as a means to progress making gender-affirming services eligible for a Medicare benefit”.

New push to fix ‘fragmented’ system

The ASPS application seeks to establish 21 Medicare items subsidising gender-affirming surgeries for people with gender incongruence aged between 18 and 50.

Procedures listed include feminising and masculinising top surgery, bottom surgery, as well as facial and voice surgery.

The ASPS says gender-affirming procedures are performed in Australia now. However, the system is “fragmented”, with very low availability, long waiting lists and high out-of-pocket costs.

Currently, some existing Medicare item descriptors ban procedures if done for gender affirmation, the ASPS explains.

Others are listed with descriptors that are a “poor fit” or inappropriate for transgender people, leaving doctors anxious about eligibility.

“Despite the lack of [Medicare] funding, these procedures are well-established for the purposes of gender affirmation,” the application says.

The ASPS said “legitimised and universal” access to gender-affirming medical interventions is an important way to improve transgender people’s mental health and overall quality of life.

ASPS president Dr Nicola Dean told ABC News they collaborated with transgender organisations and other health professionals on the application.

Medicare application considered next month

A Health Department spokesperson confirmed a sub-committee will consider the application in December. The full advisory committee will then likely assess it in 2024.

“The Australian government is committed to supporting Australians to access high-quality health care,” the spokesperson told Nine Newspapers.

“There is a range of [Medicare] items that could be used at various stages of the gender-affirming process, including GP and specialist consultation items.

“Rebates are also available for some surgical procedures which may be performed during the gender affirmation process.”

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1 Comment

  1. Stephanie Tyalor
    21 November 2023

    I am over $60,000 out of pocket after Medicare
    And 3 years after so called gender sex maker change

    No, I had to be myself
    Yes, No help from anyone including gov or non gov help made it impossible
    And NO I am not a sex workers

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