The short answer? Maybe.
Dive into the longer but far more satisfying answer below…
While some company and local government health plans cover care for transgender policy-holders, the Federal government does not and specifically excludes transition-related care from coverage.
Transition-related care may include hormone replacement therapy, mental health services, and sexual reassignment surgery (SRS). The costs of this care can easily reach into the tens of thousands of dollars, putting it beyond the reach of many who need it.
But some recent and almost unnoticeable steps by federal agencies could mean transgender care coverage federal employees and many others.
Many people believe the inner workings of the government are needlessly complex or hopelessly laborious. And in many cases they are.
So follow me into the workings of the government so I can show you.
On Dec. 2 the departmental appeals board at the Health and Human Services Department decided that the “National Coverage Determination” (basically what is covered under Medicare and Medicaid and other programs) excluding sexual reassignment surgery specifically from Medicare coverage needed to be revisited.
The coverage decision has been in place since May 6, 1981 and the original determination stated:
“Transsexual surgery for sex reassignment of transsexuals is controversial. Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental;. Moreover there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.”
The complaint that sparked this action noted that the language was terribly out of date and had no real bearing on modern day medicine. It seems HHS is inclined to agree.
But what does this have to do with Federal employees? In addition to administering Medicare, HHS is also responsible for enforcement of section 1557 of the Affordable Care Act, which covers “any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title [of the ACA].”
If you read that and thought the scope of the inquiry was extensive you are right. It covers a wide range of programs, including at least Medicare, Medicaid and the Federal Employee Health Benefits Program.
On an HHS Q and A on Section 1557 of the Affordable Care Act – which prohibits discrimination on the bases of “race, color, national origin, sex, age, or disability in certain health programs and activities” the agency answered a list of self-imposed questions, including:
“Does this mean that transition related surgery is required to be covered by health insurers?”
The answer was a simple “no.”
But the Q and A has since vanished from the site. (Update: I want to make clear the Q and A I link to is a web archive version.)
At the same time the agency issued a request for information on the same section (1557) seeking “information on a variety of issues to better understand individuals’ experiences with discrimination in health programs or activities and covered entities’ experiences in complying with Federal civil rights laws.”
The agency specifically requested examples of covered discrimination on the basis of sex, ‘including discrimination on the basis of gender identity, sex stereotyping, or pregnancy.”
While the rulemaking is far from complete these are signs the administration is open to changing how it treats its transgender employees.
This could be a huge step in getting transgender care covered under the health plans available to millions of people across the country.
I have reached out to the Office of Personnel Management and to HHS for comment. I will update if I hear anything.
Attention, Washington, D.C.-area feds: With the scene outside looking a lot more frightful than delightful Sunday afternoon, what better time to tear yourself away from the Redskins debacle and get back up to speed on dismissal and closure policies in case of bad weather or other emergencies. Last week, the Office of Personnel Management held a webinar (see above) on the subject and here’s a memo from OPM Director Katherine Archuleta: http://tinyurl.com/my7wjkf. For those who really want to go hard-core, this is the link to OPM’s updated 35-page manual on the subject: http://tinyurl.com/lslzns9.
It’s still too early to say what’s in store for tomorrow, but in a Tweet late Sunday evening, OPM officials said they will announce the operating status for D.C.-area offices by 4 a.m. Monday. As soon as we at FedLine hear something, we’ll let you know.
[This post has been updated as of 11:27 Sunday evening.]
Katherine Archuleta officially became the 10th director of the Office of Personnel Management this morning following a private swearing-in ceremony, the agency said in a news release. Archuleta, confirmed by the Senate last Wednesday to a four-year term, began the day by greeting employees in the lobby of OPM headquarters.
“OPM touches so many lives and has such a significant impact on government service,” Archuleta said in the release. “I look forward to getting to know the many dedicated, hard-working men and women who serve the public every day.”
Archuleta replaces John Berry, who left in April en route to a new gig as ambassador to Australia. Filling in as director was OPM General Counsel Elaine Kaplan, who officiated at this morning’s swearing-in ceremony, attended by Archuleta’s husband, Edmundo Gonzales.
Among other activities, Archuleta will spend the week meeting with senior staff and getting briefed on various issues facing the agency.
The 16-day partial government shutdown is officially over as President Obama has signed a stop-gap spending bill, Office of Management and Budget Director Sylvia Burwell said in a message released early Thursday morning.
“This evening, the President signed a continuing resolution that reopens the federal government and the Office of Management and Budget (OMB) issued guidance to all departments and agencies to resume operations in a prompt and orderly manner,” Burwell said. “In the days ahead, we will work closely with departments and agencies to make the transition back to full operating status as smooth as possible. This has been a particularly challenging time for Federal employees and I want to thank our nation’s dedicated civil servants for their continued commitment to serving the American people.”
Feds will receive back pay in their next paychecks, a Burwell spokesman said in a follow-up email. Agencies are “strongly encouraged” to use telework and other ”workplace flexibilities to ensure a smooth transition back to work for employees,” OPM said in a statement on its website.
The bill, approved today by the House and Senate, will fund the government through Jan. 15.
The legislation would also allow a 1 percent across-the-board pay increase for federal employees, according to a joint news release from Sens. Barbara Mikulski, D-Md., and Ben Cardin, D-Md. The release does not make clear whether added steps will be needed to ensure that the proposed raise takes effect. Here is a cut-and-paste version of the release:
WASHINGTON – U.S. Senators Barbara A. Mikulski, Chairwoman of the Senate Appropriations Committee, and Ben Cardin (both D-Md.), a member of the Senate Finance Committee, today announced that the bipartisan legislation to end the Tea Party Republican shutdown and reopen the federal government allows a 1 percent pay increase for federal employees and ensures that federal employees furloughed through no fault of their own receive their full pay.
“I’m proud to have fought on the front lines for federal employee pay as hard as federal employees fight on the front lines each and every day for America,” Senator Mikulski said. “The promise of a modest pay raise and back pay for furloughed government employees are good first steps in recognizing the value of federal workers. They have been the targets of unending attacks. They’ve been furloughed, laid off and locked out through no fault of their own. I believe federal employees should never be scapegoats in fights over deficit reduction.”
“The government shutdown was a real punch in the gut to federal workers who were already reeling from multi-year pay freezes, sequestration cuts and furloughs, as well as threats to health and retirement benefits. These hardworking public servants did not cause our economic crisis, but they paid a heavy price. I’m proud we were able to fulfill our promise to make them whole again with back pay and finally break through the pay freeze with a modest adjustment for next year,” said Senator Cardin. “As they return to doing their work on behalf of the American people, I will continue to fight to keep federal workers from being pawns in every budget battle that lies ahead.”
As Chairwoman of the Senate Appropriations Committee, Senator Mikulski fought to ensure the final agreement to reopen the federal government would permit the President to implement his plan for a 1 percent pay raise in January, 2014. Senator Cardin introduced the Federal Employee Retroactive Pay Fairness Act, which was cosponsored by Senators Mikulski, Mark Warner (D-Va.) and Tim Kaine (D-Va.). The Cardin bill, which was included in the final agreement approved Wednesday, guaranteed that federal workers who were furloughed because of the lapse in federal funding or government shutdown would receive their full pay.
Federal employee pay has been frozen for three years with no cost-of-living adjustments, leaving families stressed and stretched. They have been subjected to rolling furloughs since March due to sequester and have also been required to pay 2.3 percent more from their salaries into their retirement plans.
Maryland is home to the headquarters of 20 major federal agencies, from the Social Security Administration to the Food and Drug Administration. More than 130,000 federal employees live and work in Maryland, serving the nation and serving the world.
The bipartisan legislation passed today funds the government through January 15, 2014 and extends our nation’s debt limit through February 7, 2014. It also starts the budget conference that Democrats have been fighting to start for the past six months so Congress can come together on a long-term solution. The House and the Senate will name conferees and the agreement will call for the budget conference to finish by December 13th. The legislation now moves to the White House to be signed into law by President Obama.
Officially, today (i.e., Oct. 14, marking Columbus Day) remains on the books as a paid federal holiday. But because of the partial government shutdown, only a limited number of federal employees are scheduled to be paid for it.
Even employees deemed “excepted” (or as many feds put it, “essential”) during the shutdown must take today as an unpaid furlough day unless required to report to work, according to Office of Personnel Management instructions (check out pp. 12 and 13). As OPM puts it in a helpful question-and-answer format:
The closing of a vast swath of government operations is now under way as this Office of Management and Budget memo makes clear. The U.S. Agriculture Department, meanwhile, has wasted no time taking down its website. The Office of Personnel Management’s site, however, is still live, with a page with guidance on everything you probably never wanted to know about employee furloughs.
As most Federal Times readers probably know, the Office of Personnel Management yesterday announced 2014 rates for the Federal Employees Health Benefits Program, both for health plans as well as dental and vision. In comparison with trends from just a couple of years ago, next year’s increases are relatively modest, but–as federal employees unions were quick to point out–they are still increases as a time when many feds have lost income because of furloughs and everyone remains under the pay freeze now in place for almost three years.
We want to get your feedback. Are the increases for your health plan manageable or will it be tough to make the additional payments? Or is the impact somewhere in between? If you’re interested in talking to us for an upcoming story, please send me an email at firstname.lastname@example.org and let me know how best to reach you.
Nearly a decade after he died, the complicated marital turnabouts of a U.S. Forest Service employee named Don King gave rise Friday to a ruling by the U.S. Court of Appeals for the Federal Circuit.
First, some background. Try to follow along, it’s complicated.
In 1967, King married a woman named Diana. They divorced in 1980. They remarried in 1981. Then, they divorced again 18 months later. And yet they held themselves out to be married for years afterward, living in the same house, keeping joint accounts and even celebrating their (original) anniversary.
But in 2002, Don moved out. He married another woman, Kathryn. Before he died in 2004, Don designated Kathryn to receive his lump sum accrued annuity.
That’s when things got messy.
Both Kathryn and Diana claimed to be Don’s wife and, after litigation, the pair struck a deal.
Diana agreed to pay Kathryn $50,000 to resolve Don’s medical and funeral expenses. And Kathryn agreed that if she got Don’s annuity payments, the money would belong to Diana.
Then, Kathryn changed her mind. And the matter ended up in court again. Meanwhile, she applied to the Office of Personnel Management for survivor annuity funds. OPM made payments from 2004 to 2007.
But after a court ruled the settlement deal enforceable, Diana applied for survivor payments, too, prompting OPM to revoke Kathryn’s payments.
It hardly ends end there. Along came settlement No. 2, in which Kathryn released any claim to any payment Diana owed–including for Don’s expenses–while Diana waived “all claims to any future payment” that Kathryn might receive. Kathryn also turned over more than $40,000 that she received from OPM into a trust account for Diana.
Meanwhile, back at OPM, officials eventually found Diana was entitled survivor benefits. And then OPM went after Kathryn, seeking to recover the money she’d received. Kathryn didn’t deny she received the money, but argued she’d already transferred the money to Diana.
OPM didn’t back down. Once more, the matter ended up in litigation. Ultimately, Kathryn couldn’t receive a waiver from the Merit Systems Protection Board.
But, in a ruling one would cautiously assume to be the last word, the Court of Appeals for the Federal Circuit Friday overturned the MSPB.
The court found, first of all, that Kathryn wasn’t at fault, as she was collecting benefits at a time when she thought she was entitled to them. It also ruled that she deserved a waiver, saying she’d aimed all along to transfer Don’s retirement benefits back to Diana.
“Because the Board failed to address the substantial evidence demonstrating that recovery of the overpayment to Kathryn was against equity and good conscience, we reverse,” the court ruled.
Like the Don himself, the case is pretty complicated. So you read the ruling for yourself here.
The Office of Personnel Management is again asking feds what they think of their benefits, according a recently posted memo on the agency’s web site.
OPM will be administering the Federal Employee Benefits Survey this summer by email to a random sample of workers, acting OPM Director Elaine Kaplan said in the Aug. 13 heads-up. The survey was last done two years ago after traditional benefits questions were dropped in 2010 from the Federal Employee Viewpoint Survey. Completing the benefits survey should take about 15 minutes and doing it during work hours is OK, Kaplan indicated.
The survey’s chief purpose is to measure benefits’ “importance, adequacy and value” to make sure that they mesh with employee needs and best practices, Kaplan wrote. The results will be reported government-wide and used for policy and educational purposes.
How to dramatize the largely hidden loss of experience and expertise as federal workers call it quits?
Here’s the National Active and Retired Federal Employees Association’s solution: On its web site, the group has built an online ticker that seeks to track the impact of that exodus down to the hour. Based on Office of Personnel Management data, NARFE calculates that the nation has lost an average of 10,000 years of federal worker experience every day since Jan. 1. It also suggests that the current political and fiscal climate is not inconsequential.
“Sure, people retire,” the group says on the site. “They deserve to. But why are we losing waves of valuable federal workers in 2013? Could it be because of proposals in Washington that freeze federal worker pay year after year, furlough workers with families and threaten to tear down the benefits that federal workers earned?”
What do you think, readers? Could it?