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New SSA Rules on Gender Designation

Last week, the Social Security Administration (SSA) published new rules that make it easier for the estimated 700,000 transgender Americans to update their Social Security records to reflect their gender designation.

Prior to the new rules, individuals were required to submit documentation of specific surgeries in order to have their Social Security records reflect a change in gender identity. Under the new rules, individuals can submit government-issued documents (such as a passport) that reflect the change, or may present a "medical certification of appropriate clinical treatment of gender transition" (a letter from an individual's physician) to the Social Security Administration.[1]

The new rules align SSA's policy with those of other federal agencies, and, generally, updating gender identification on an individual's Social Security record will have no impact on benefits. However, individuals who are enrolled in Medicare or who are enrolled in both the Medicaid and Supplemental Security Income (SSI) programs who change their record may experience automatic denials for coverage of services that appear inconsistent with a gender marker in their Social Security records. These automatic denials are a result of anti-fraud efforts to reduce the risk of inappropriate and erroneous billing by providers, but they have the unintended consequence of denying legitimate services to beneficiaries. Denials can usually be resolved by the provider adding a specific billing code, contacting the plan, or helping the individual request a formal coverage determination.[2]

SSA's policy change is a positive step forward for transgender Americans, who face continued health and economic disparities and discrimination.

DOMA Struck Down: Implications for Federal Benefits, Including Medicare

This week, in a victory for equality and health equity, the Supreme Court struck down the Defense of Marriage Act (DOMA).  Millions of LGBT individuals, couples, and families are affected by the ruling.  This includes older same-sex married couples who, under DOMA, faced barriers and discrimination for purposes of key federal benefits including Social Security and Medicare.

The Obama Administration is tasked with ensuring that the federal government makes the appropriate changes to federal policy to ensure full federal recognition of same-sex married couples. The Center for Medicare Advocacy will continue to work with policymakers and administrators to ensure that eligible same-sex married couples enjoy the same health and financial security that Medicare provides other eligible married people.

For more information, contact Policy Associate Xenia Ruiz ( in the Center for Medicare Advocacy's Washington, DC office at (202) 293-5760.


[1] Social Security Administration, Program Operations Manual System (POMS), available at
[2] National Center for Transgender Equality, Transgender People and the Social Security Administration, available at


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