The Health and Human Services Department has decided to forgo the public comment process, and instead rely on a panel of experts to determine whether to lift its 32 year-old policy against covering Sex Reassignment Surgery (SRS) in its Medicare and Medicaid Services.
The last time the issue was on the table was in 1981, and it was determined by the department to be an experimental surgery and thus was not included in the policies. As transgender healthcare gains more of a substantial place in society, organizations including universities, colleges, and workplaces are including everything from mental health evaluations for trans people to SRS in their policies.
HHS was initially going to open this process up to public comment, which would have left the idea of providing healthcare to transgender people open to criticism both from anti-transgender activists and conservative members of congress. The Health and 
Human Services Department has instead decided to have the case reviewed through the independent Department Appeals Board process.
"An administrative challenge to our 1981 Medicare national coverage determination concerning sex reassignment surgery was just filed," an HHS spokesperson told The Hill Friday. "This administrative challenge is being considered and working its way through the proper administrative channels. In light of the challenge, we are no longer re-opening the national coverage determination for reconsideration."
National Center for Transgender Equality Executive Director Mara Keisling said:
"What HHS did is very positive news from our perspective. They haven't stopped considering coverage of sex reassignment surgery under Medicare. Instead, the Center for Medicare and Medicaid Services (CMS), which is housed under HHS, decided to use a different administrative process to change whether Medicare covers medically necessary sex reassignment surgery. What matters is that we get a fair and scientific process. We'll win that every time."
Regarding the cost, what many don't realize, and what the media almost never reports, is the addition of SRS to the Medicaid and Medicare system would actually cause a reduction in the overall cost of healthcare. According to Empire State Pride Agenda, in New York transgender persons utilizing the services would make up approximately .0033% of the 
total Medicaid budget. The additional cost of SRS would be more than offset by decreases in high cost areas as mental health, suicide attempts, HIV, and substance abuse treatment - which often result from an individual being denied the healthcare they need.