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Congressional ____
S£Research Service
FY2024 NDAA: TRICARE Coverage of Gender
Affirming Care
July 20, 2023
Background
The Department of Defense (DOD) administers a statutory health entitlement (under Chapter 55 of Title
10, US. Code), through the Military Health System (MHS). The MHS offers health care benefits and
services through its TRICARE program to approximately 9.6 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 the annual National Defense
Authorization Act (NDAA).
During ongoing deliberations on the fiscal year (FY) 2024 NDAA, Congress has 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. Gender-
affirming care includes non-surgical 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 CFR 199.2), including non-surgical treatments for [gender dysphoria], are
covered [for all beneficiaries] when provided by a TRICARE-authorized provider. For hormone therapy,
a beneficiary diagnosed with gender dysphoria must also meet the eligibility criteria outlined in the
Endocrine Society's clinical practice guideline for treatment of gender dysphoria. Under 10 U.S.C.
@ 1079(a)(1 1)), 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.
This statutory prohibition applies only to health care services covered by the TRICARE program for
beneficiaries; DOD may pay for gender-affirming surgical care through the Supplemental Health Care
Program (SHCP) for active duty members of the uniformed services. SHCP is authorized under 10
U.S.C. @1074(c), 32 C.F.R. @199.16, Health Affairs Policy 12-002, and the TRICARE Operations
Congressional Research Service
https://crsreports.congress.gov
IN12203
CRS INSIGHT
Prepared for Members and
Committees of Congress](ViewImageLocal?handle=hein.crs/govemgm0001&div=1&collection=&method=preview&ext=.png&size=3)
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