Uncle Sam just got a whole lot more sensitive.
POLICY: It is VHA policy that medically necessary care is provided to enrolled or otherwise eligible intersex and transgender Veterans, including hormonal therapy, mental health care, preoperative evaluation, and medically necessary post-operative and long-term care following sex reassignment surgery. Sex reassignment surgery cannot be performed or funded by VHA or VA.
ACTION:
- Each Veterans Integrated Service Network (VISN) Director must ensure that necessary and appropriate health care is provided to all enrolled or otherwise eligible Veterans based on the Veteran’s self-identified gender, regardless of sex or sex reassignment status.
- Each Medical Center Director and Chief of Staff are responsible for ensuring that:
- Transgender patients and intersex individuals are provided all care included in VA’s medical benefits package, including, but not limited to:
- Hormonal therapy
- Mental health care
- Preoperative evaluation
- Medically necessary post-operative and long-term care following sex reassignment surgery
- Patients will be addressed and referred to based on their self-identified gender. Room assignments and access to any facilities for which gender is normally a consideration (e.g., restrooms) will give preference to the self-identified gender, irrespective of appearance and/or surgical history, in a manner that respects the privacy needs of transgender and non-transgender patients alike. Where there are questions or concerns related to room assignments, an ethics consultation may be requested.
- The documented sex in the Computerized Patient Record System (CPRS) should be consistent with the patient’s self-identified gender. In order to modify administrative data (e.g., name and sex) in CPRS, patients must provide official documentation as per current VHA policies on Identity Authentication for Health Care Services and Data Quality Requirements for Identity Management and Master Patient Index Functions.
- Sex reassignment surgery will not be provided or funded.
- Non-surgical, supportive care for complications of sex-reassignment surgery will be provided.
- While care is delivered to the Veteran based upon that Veteran’s self-identified gender, there may be health issues associated with some transgender patients that necessitate appropriate sex specific screenings and/or treatments. For example, a MTF transsexual patient over the age of 50 may require breast cancer and prostate cancer screening. A FTM transsexual patient may require screening for breast and cervical cancer.
- A diagnosis of GID, or other gender dysphoria diagnoses, is not a pre-condition for receiving care consistent with the Veteran’s self-identified gender.
- All other health services are provided to transgender Veterans without discrimination in a manner consistent with care and management of all Veteran patients.
- All staff, including medical and administrative staff, are required to treat as confidential any information about a patient’s transgender status or any treatment related to a patient’s gender transition, unless the patient has given permission to share this information.
- Mandated diversity awareness is maintained and a zero-tolerance standard for harassment of any kind.
James Pate, MD 