Medicare delays gender-affirming surgery funding

Despite 92% public support and clear evidence of need, the Medical Services Advisory Committee wants more long-term data before approving coverage

For trans Australians who need surgery under medicare, the wait just got longer. The Medical Services Advisory Committee (MSAC) met in April to consider whether Medicare should fund gender-affirming surgeries for adults. After reviewing thousands of submissions, 92% of which support public funding, they've asked for more evidence before making a decision.

This matters because right now, if you're trans and need surgery in Australia, you're looking at paying anywhere from $20,000 to over $80,000 out of pocket. Some people drain their super. Others travel overseas. Most go without.

The Australian Society of Plastic Surgeons put forward 30 new Medicare items covering chest, genital, facial and voice surgeries. If approved, patients with private health insurance could receive 75% of the scheduled fee back through Medicare rebates. However, the MSAC states that it requires more substantial evidence of long-term outcomes before it'll approve funding.

The evidence question

MSAC acknowledged there's a clear unmet need. They know surgery can significantly improve mental health, body image and quality of life for trans people. Research shows less than 1% of people regret having gender-affirming surgery – lower than regret rates for knee operations (10%) or cancer procedures (24%).

But the committee wants data on what happens to patients five, ten, and fifteen years down the track. Most existing studies only follow people for a few years. They're also concerned that guidelines have changed over time, making older research less relevant to current patients.

One particular sticking point was the committee's inability to agree on age limits. The surgeons suggested 18 and over. Some healthcare professionals argued for 25, when the brain is fully developed. Trans advocates point out this would mean years of additional waiting for young adults who are sure about their needs.

The stakes are high. One Australian study found 63% of trans women wanted facial feminisation surgery, but only 6% had accessed it. Trans people who need to but can't access surgery have a 71% higher chance of reporting a suicide attempt.

The bureaucratic maze

Even if Medicare funding gets approved, barriers will remain. Most states and territories explicitly exclude or restrict gender-affirming surgery in public hospitals. Queensland and the Northern Territory ban it outright. NSW refers to it as "discretionary," leaving decisions to individual hospital directors. In Victoria, some gender affirming procedures are listed as aesthetic procedures and are only available in public hospitals if they are due to significant clinical symptoms or significant deformity.

MSAC also wants clearer care pathways. They're calling for multidisciplinary teams – at least three health professionals, including surgeons, GPs, psychologists or psychiatrists – to assess patients before surgery. While comprehensive care makes sense, there are serious concerns that it will create additional gatekeeping, which may delay or even block necessary treatment.

The committee is concerned about the increase in people seeking gender-affirming care, particularly younger people and those identifying as non-binary. They estimate the current unmet demand at over 227,000 surgeries.

The MSAC has requested the Department of Health undertake a more comprehensive evidence review.

A decision isn't expected for at least another year. Meanwhile, trans Australians continue paying extraordinary amounts for essential healthcare, traveling overseas for surgery, or simply living without.