Medicaid officials in Washington state are to change regulations to exclude gender reassignment surgery from the healthcare scheme.

Washington is one of very few US states where sex-change procedures have been covered by Medicaid, the state-federal programme that provides health coverage for the poor and disabled.

The Seattle Times reports that a state appeals board ordered Medicaid to pay for two people to travel out of state to undergo sex-change operations. The state estimates the procedures, also known as sex-reassignment surgery, cost $50,000 to $60,000 each.

“This is very controversial and in need of clarity,” Washington state Medicaid director Doug Porter said. “We’ve decided to make it crystal clear that it’s not a covered service.”

The state does plan to continue covering other services, such as hormone treatment and psychotherapy, for people diagnosed with gender-identity disorders. State officials argue that those treatments are just as effective as surgery but are less risky and far less expensive.

“We understand this is a very real condition for some people,” Porter said. “We just think psychotherapy and hormone treatment is a better way to go.”

Many transgender people and medical experts who treat gender-identity disorders disagree. In some cases, they argue, surgery is the only effective treatment.

“It’s the only thing that repairs our mental health and makes us feel whole and able to get back on track,” said Lee, one of the two people who won on appeal last month. Lee is her middle name; she requested that her full name not be published.

Lee, 51, said she has been undergoing hormone treatment and living as a woman for the past six years. She is scheduled to undergo sex-change surgery this fall in Colorado.

Chris Daley, director of the California-based Transgender Law Centre, told The Times that the state’s plan to remove sex-reassignment surgery from its list of covered services is “pure politics and bad public policy.”

Daley added that there is evidence, even in Washington state, that people who undergo sex-change surgeries often are able for the first time to become productive members of society.

“We all understand the impulse to rein in costs,” Daley said, “but there’s no cost-benefit in denying necessary health care.”

People with gender-identity disorder feel trapped inside a body of the opposite sex. The condition is often associated with other illnesses, including depression.

While gender-identity disorder has been recognized for more than two decades by the American Psychiatric Association, few government or private insurance programs pay for treatment.

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