FY2025 NDAA: TRICARE Coverage of Gender-Affirming Care (CRS Report for Congress)
| Release Date |
Aug. 2, 2024 |
| Report Number |
IN12401 |
| Report Type |
Insight |
| Authors |
Bryce H. P. Mendez |
| Source Agency |
Congressional Research Service |
Summary:
The Department of Defense (DOD) administers a statutory health entitlement (under Title 10, Chapter 55,
of the U.S. Code), through the Military Health System (MHS). The MHS offers health care benefits and
services through its TRICARE program to approximately 9.5 million beneficiaries composed of
servicemembers, military retirees, and dependent family members. Congress often specifies certain
TRICARE coverage parameters (e.g., how health care services may be delivered, and whether
beneficiaries may be subject to cost-sharing requirements) through an annual National Defense
Authorization Act (NDAA).
During ongoing deliberations on an FY2025 NDAA, some Members of Congress have expressed interest
in TRICARE coverage policies for gender-affirming care. Defense Health Agency (DHA) Procedural
Instruction 6025.21 defines gender-affirming care as “clinical services that support an individual’s
physical and [behavioral health] as they define, explore, and align with their gender identity.” Genderaffirming care includes nonsurgical care (e.g., hormone therapy and psychotherapy) and surgical care
(e.g., gender-affirming surgery).
The TRICARE Policy Manual stipulates that “medically or psychologically necessary and appropriate
medical care (as defined in 32 C.F.R. §199.2), including nonsurgical treatments for [gender dysphoria],
are covered [for all beneficiaries] when provided by a TRICARE-authorized provider.” The TRICARE
Policy Manual also clarifies that hormone therapy is a covered service for an adult or adolescent
beneficiary diagnosed with gender dysphoria and who meets the eligibility criteria outlined in the
Endocrine Society’s clinical practice guideline for treatment of gender dysphoria. Under 10 U.S.C.
§1079(a)(11), TRICARE is explicitly prohibited from covering gender-affirming surgical care for
beneficiaries except to treat individuals with an intersex condition due to congenital malformations or
chromosomal abnormalities.
