Among the most frustrating and dangerous things for many trans people is having inaccurate identification that does not match their gender identity. It is especially troubling with documents like the Medicare card for which there is no programmatic or practical reason to include a gender marker on the card. This bureaucratic mistake causes trans seniors and people with disabilities who are Medicare beneficiaries to frequently and unnecessarily be outed as trans whenever they show their Medicare cards to access services. The gender marker is in big letters smack in the middle of the Medicare card and can’t be missed by any pharmacist or a doctors’ office front desk staff–people who just don’t have a reason to know about your trans-related medical status.
NCTE has been working to fix this problem and will not stop until it is done.
Who Issues Medicare Cards?
The Medicare program is run by an agency within the U.S. Department of Health and Human Services called CMS, or the Center for Medicare & Medicaid Services. [You won't be the first person to wonder why it isn't abbreviated as CMMS, but it's not--they call it CMS.] Technically, CMS specifies what information is on the cards, but the cards are actually printed using information from the Medicare enrollee’s Social Security account, which is managed by the Social Security Administration (SSA).
This means that NCTE is working to solve the problem in two ways with two different agencies. First, we are asking CMS to remove the harmful and unnecessary gender field from the Medicare card. Second, we have been working with the SSA to modernize their gender change policy to match other updated federal policies such as the State Department’s passport policy, making it possible for trans Medicare enrollees to have the correct gender listed on their cards. If trans seniors and others can get their gender marker changed to match their gender identity, it won’t matter as much that it is listed on their Medicare card.
Why Does the Medicare Card Have Gender on it Anyway?
No one in the federal government has a good answer for this because there is no programmatic answer for it. The gender marker is on the card because it always has been. This is similar to why the gender marker is on driver licences. Before picture IDs, government agencies put lots of identifying information on IDs to help with matching a card to its user. With the advent of picture IDs, most states have limited the number of personal characteristics (such as race, weight and hair color) listed on licenses, but no one until recently had thought to remove gender.
This is not uncontroversial among trans people either, by the way. Many who are able to change the gender on their IDs like having a corrected gender marker to prove their gender. Those who can’t meet whatever change requirement there is or those who can’t afford new ID fees are stuck with embarrassing and potentially dangerous moments every time they show their ID.
What Are We Asking the Federal Government To Do?
NCTE is advocating for two government policies that could alleviate the problem we face with Medicare cards–one CMS policy and one SSA policy.
1. CMS should remove the gender marker from the Medicare card. It is not necessary for CMS or for healthcare providers who accept Medicare. And, as we have said, it is an unfair and dangerous violation of privacy for Medicare enrollees.
2. SSA should update its gender change policy to reflect the modernized policy used by the State Department’s Passport Office and many states’ motor vehicle agencies. Rather than require proof of particular surgeries, SSA should require proof from a medical provider that the person has had appropriate medical care for transition.
How Long Will It Take To Fix This?
Good question. We know it can be frustrating that so many needed federal policy changes take what seems like too long, but the federal government is a sticky-slow bureaucracy and, despite our best work, everything takes longer than any of us would like.
Honestly, we too are increasingly frustrated that SSA has not yet followed the very reasonable model set by the State Department on passports. We continue to advocate with them for a better policy.
However, CMS faces a legitimate and understandable challenge in redesigning the Medicare card without the gender marker. While we are advocating for a slightly redesigned Medicare card because of the gender marker problem, other interests — including many in Congress — are advocating for a significantly redesigned card because the cards also currently show enrollees’ Social Security numbers. In fact, there are several bills in Congress that would mandate the government stop using SSNs on various government IDs, including Medicare cards.
This is no easy or cheap task, it turns out. The Social Security number is the account number for Medicare, so CMS can’t just remove the number; they must design an entirely new records system giving all Medicare enrollees new account numbers.
In fiscal year 2006, Congress mandated that CMS study how much it would cost to switch over to a non-SSN system. The estimates range from $300 to $870 million. So, though removing the gender marker from the card seems like a no-brainer to us, there are complicating factors, which are making this take longer than we would like. We are caught in this larger debate about SSNs.
NCTE will continue to advocate with CMS, SSA and Congress until no more trans people who rely on Medicare for their healthcare are forced to show inappropriate ID to people who just don’t need to know.
To read more about the issue of Social Security numbers on Medicare cards, please see these articles:
NY Times May 22, 2008
AARP November 2008