FAQ: Removing the “Gender Alterations” Exclusion from the VA’s Medical Benefits Package

1. What is the VA’s policy regarding health care for transgender Veterans?

The VA is committed to ensuring that, as an integrated service and benefits delivery system, is welcoming of all Veterans, including those with minority gender identities and expressions. As part of this commitment, the VA provides all medically necessary gender affirming care to transgender Veterans with the exception of gender affirming surgical interventions due to an exclusion in the VA’s medical benefits package.

2. Is the VA planning to remove this exclusion from its benefits package?

Yes. The VA wants all eligible Veterans to have access to clinically appropriate, inclusive health care services. In 2016, the VA received a Petition for Rulemaking (PFR) to remove the “gender alterations” exclusion that prevented and continues to prevent the VA from performing medically necessary gender-affirming surgeries. This petition argued that the exclusion was discriminatory. Revising the medical benefits package would enable a safe, coordinated continuum of care that is Veteran-centric.

3. What is the VA doing to ensure transgender Veterans are not facing discrimination?

The VA is currently reviewing its policies to ensure that transgender Veterans do not face discrimination based on their gender identity or expression. This review includes an evaluation of statutory and regulatory requirements to build out a continuum of care that provides all medically necessary services for transgender and gender diverse Veterans.

4. What are the steps involved to permanently remove the exclusion?

The VA would formally grant the PFR and initiate rulemaking to remove the exclusion. The entire rulemaking process, itself, can take two years and includes a period of public comment.

Rulemaking is the term used when a federal government agency creates, modifies, or removes rules published by the Code of Federal Regulations (also known as the CFR). Rulemaking to remove this exclusion is recommended to align the VA with current Administration priorities, best medical practice, research, and professional health organizations. Revising the medical benefits package would enable a safe, coordinated continuum of care that is Veteran-centric.

5. What about transgender Veteran care during the rulemaking process?

During the rulemaking process, the VA will continue to provide or pay for the services it currently offers, including corrective procedures after gender-affirming surgeries a Veteran obtains outside the VA, hormone therapy, and other gender-affirming care.