Pa. Man Sues to Overturn State Medicaid's Trans Exclusions

The lawsuit is among the first to challenge state laws on the basis of civil rights provisions written into the Affordable Care Act.

A transgender man in Pennsylvania is taking on his state Medicaid program's exclusion of coverage for gender-affirming surgery, filing a lawsuit contending that the Affordable Care Act (also known as Obamacare) requires the state-funded health care provider to cover a hysterectomy the man's doctors have deemed medically necessary.

Conservative newspaper The Washington Times reports that the lawsuit is the first of its kind. But a trans man in Minnesota won a historic victory last March when a federal court determined that health care providers and hospitals accepting federal Medicare or Medicaid funds are subject to the ACA's prohibition of discrimination based on sex, which extends to transgender individuals.

Pennsylvania is one of several states that currently enforce coverage exclusions in Medicaid for transition-related care, though in September, the federal government proposed rules (not yet implemented) that would ban such exclusions in nearly all plans nationwide. In 2014, New York and Oregon both did away with similar bans on trans coverage.

The lawyer for the Pennsylvania man, identified only as school teacher John Doe, 30, said the state's ban on funding gender-affirming surgeries flies in the face of Obamacare regulations which prohibit discrimination on the basis of gender identity.

“Under Obamacare, it’s got to be provided,” lawyer Julie Chovanes, a transgender woman who represents Doe and runs the Trans Resource Foundation, told the paper. “It can’t be discriminatorily not provided when medically necessary and prescribed by a doctor.”

Advocates for comprehensive trans health care have advanced similar arguments, though critical loopholes still exist in current interpretation of the ACA's trans-inclusive coverage. For example, health care providers cannot deny transgender people appropriate preventative care, but providers are not categorically required to cover transition-related care, including hormone therapy, mental health services, and gender-affirming surgeries.

If the Pennsylvania lawsuit is sucessful, it could help prompt a change in the ACA's interpretation that may allow for greater coverage of gender-affirming surgery, which has already increased in states like New York and California. Such an inclusive interpretation would also allow transgender patients to access to broader mental health and transition-related health care, as affirmed by the American Psychiatric Association and American Medical Association, according to Sarah Warbelow, legal director of the Human Rights Campaign.

“Mental health services are important for a wide variety of people for a wide variety of needs,” Warbelow told the paper. “And certainly transgender people do seek relationships with mental health care providers, but the appropriate treatment as deemed by the American Medical Association and every major physical and mental health-care organization out there is to affirm people in their gender identity.”