Two transgender Wisconsin residents are suing the state’s health department, alleging discrimination because their desired gender reassignment surgery is not covered by Wisconsin Medicaid.

In the complaint, plaintiffs Cody Flack and Sara Ann Makenzie challenge a 1997 Wisconsin regulation that prohibits the state’s Medicaid program from covering what it refers to as “transsexual surgery.”

The regulation, which is similar to provisions in nine other states, says such surgery is medically unnecessary. The plaintiffs say the regulation “flies in the face” of the medical consensus on gender dysphoria, the “clinically significant distress associated with having a gender identity ... that conflicts with the sex one was assigned at birth.”

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Flack and Makenzie have both been clinically diagnosed with gender dysphoria, and have received other medical treatments including surgery and hormone replacement therapy, according to the lawsuit. Both have experienced severe emotional distress as a result of the coverage being denied, according to the suit.

“Wisconsin treats its transgender Medicaid beneficiaries as second-class citizens and their transition-related health-care needs as ‘unnecessary,’ ” the claim reads.

Flack, a transgender man, and Makenzie, a transgender woman, are asking a federal judge to declare the provision unconstitutional under the Affordable Care Act and to block the state from denying them coverage. They are also seeking damages for related “economic and non-economic injuries” and legal fees.

“Each of them has suffered, and is continuing to suffer, symptoms of gender dysphoria, severe emotional distress, and physical injury and pain, all of which would be avoidable if they had access to this medically necessary care,” the claim reads.