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Program (SHCP) for “active duty members of the uniformed services.” DOD uses its authority under 10 U.S.C. §1074(c) to administer SHCP. Title 32, Part 199.6, of the Code of Federal Regulations, Health Affairs (HA) Policy 12-002, and the TRICARE Operations Manual describe SHCP requirements and procedures. HA Policy 12-002 stipulates that SHCP “provides an avenue to lawfully cover otherwise non- covered services for Service members in circumstances that will enable them to return to full duty/worldwide deployable status, or to reach their maximum rehabilitative potential.” Examples of noncovered services include certain emerging medical therapies and services, fertility services, and unique rehabilitative services.

DHA policy outlines the process for providing gender-affirming surgical care to an active duty servicemember diagnosed with gender dysphoria, which includes requirements for the servicemember to obtain endorsements from their respective transgender care team and their chain of command prior to being authorized care.

Table 1 lists the proposed gender-affirming care-related provisions included in the House-passed (H.R. 2670) and Senate Armed Services Committee (SASC)-reported (S. 4638) versions of an FY2025 NDAA.

Table 1. FY2025 NDAA Legislative Proposals

House-passed H.R. 8070

Senate Armed Services Committee-reported S.

4638

Section 579C would prohibit an Exceptional Family Member Program from providing “gender transition procedures” or providing referrals for “gender transition services” to a minor dependent child. The provision would also prohibit the approval of a change of duty station due to a minor dependent child having a lack of access to gender transition services.

No similar provision.

Section 713 would amend Title 10, Chapter 55, of the U.S. Code to prohibit DOD from providing or paying for gender- affirming surgical care and hormone therapy for all beneficiaries.

Section 708 would amend Title 10, Chapter 55, of the U.S. Code to prohibit the use of DOD funds for performing or facilitating “sex change surgeries.”

Section 709 would amend 10 U.S.C. §1079(a) to prohibit TRICARE coverage of gender-affirming hormone therapy “that could result in sterilization” for beneficiaries under 18 years of age.

Source: CRS analysis of legislation on Congress.gov.

Discussion

Between January 1, 2016, and May 14, 2021, DOD reportedly spent approximately $15 million to provide gender-affirming care (surgical and nonsurgical care) to 1,892 active duty servicemembers. DOD has not publicly reported any cost or utilization data of gender-affirming care for nonactive duty beneficiaries. Some studies have described utilization rates of TRICARE-covered gender-affirming care for certain nonactive duty beneficiaries. For example, a 2019 study stated that “between October 2009 and April 2017, 2,533 youth received” gender-affirming care through the MHS.

Congress continues to debate whether federal health programs, including TRICARE, should cover gender-affirming care and related support services. Some observers argue that federal taxpayer funds should not be used to pay for gender-affirming care that they perceive as “costly and controversial” and that such care could affect a servicemember’s ability to be “combat-ready” or “deployable.” Other observers argue that there is a “growing consensus” among medical experts that gender-affirming care is medically necessary and that health payers should ensure coverage of these services.

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Section 713 of the House-passed bill would amend Title 10, Chapter 55, of the U.S. Code by adding a new section that prohibits DOD from providing or paying for gender-affirming surgical care and hormone treatment used to treat gender dysphoria under TRICARE and SHCP. The SASC-reported bill includes two similar provisions. Section 708 would also amend Title 10, Chapter 55, of the U.S. Code by adding a new section that prohibits the use of DOD funds for performing or facilitating “sex change surgeries.” Section 709 would amend 10 U.S.C. §1079(a) to more narrowly prohibit TRICARE from covering gender-affirming hormone therapy that “could result in sterilization” for beneficiaries under 18 years of age.

In certain instances, a dependent family member diagnosed with a “current and chronic” mental health condition requiring “inpatient or intensive (i.e., greater than one visit monthly for more than 6 months) outpatient mental health service” may access coordination and support services through the Exceptional Family Member Program (EFMP). Dependent family members diagnosed with gender dysphoria as a mental health condition, per the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) definition, may be eligible to enroll in EFMP.

DOD policy also allows EFMP-enrolled servicemembers to request a reassignment to another duty station before meeting the minimum time-on-station requirement, and to be afforded certain housing flexibilities during their relocation to another duty station. Section 579C of the House-passed bill would prohibit provision of gender transition services through an EFMP. Such services include surgery, medication, and providing or making referrals for a minor dependent child to obtain “gender transition procedures, including surgery or medication.” The provision would also prohibit the military services from approving a servicemember’s request for early reassignment to another duty station due to lack of access to gender transition services for a minor dependent child.

Author Information

Bryce H. P. Mendez Specialist in Defense Health Care Policy

Disclaimer

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