ACLU Challenges Minnesota’s Ban on Medicaid Coverage of Transition-Related Surgery
Lawsuit Says Ban Arbitrarily Denies Transgender People Necessary Healthcare
ST. PAUL, Minn. – The American Civil Liberties Union and the ACLU of Minnesota filed a lawsuit today in Minnesota State Court to challenge the coverage ban on transition-related surgery for transgender people on Medical Assistance and Minnesota Care, the state’s public insurance programs for low-income residents.
Minnesota’s Medical Assistance program provides coverage for medically necessary care for virtually every type of medical condition. But for gender dysphoria, Minnesota law mandates a sweeping and categorical exclusion of all transition-related surgical care without any regard to whether the treatment is medically necessary for an individual recipient. As a result of this sweeping exclusion, most surgical treatments for gender dysphoria are excluded from coverage, even though the same or substantially equivalent treatments are required to be covered under the federal Medicare program and private insurance plans regulated by the state of Minnesota.
“For many transgender people, transition-related surgery is a medical necessity and can sometimes be a matter of life and death. Transgender Minnesotans — like everyone else — should be able to receive adequate health care based on medical standards of care,” said Joshua Block, attorney in the ACLU’s Lesbian, Gay, Bisexual, and Transgender Project. “Every major medical organization has recognized that policies banning coverage for medically necessary transition care have no basis in modern medical science. Minnesota’s statute is a historical relic based purely on disapproval of transgender people.”
The complaint was filed on behalf of plaintiffs Evan Thomas and OutFront Minnesota, the state’s leading LGBTQ rights group, arguing that this ban is discriminatory and has no basis in medical science.
Evan Thomas is currently on Medical Assistance and has been diagnosed with gender dysphoria. After fighting depression all his life, he began hormone therapy and legally changed his name and gender earlier this year. But he has been denied coverage for medically necessary transition-related surgery.
“A weight was lifted when I first began my gender transition and realized I didn’t have to pretend to be a woman anymore,” said Evan Thomas. “Being denied surgical treatment is harmful to my health and well-being every day I’m forced to live in this body.”
OutFront is Minnesota’s largest LGBTQ rights organization and is regularly contacted by transgender individuals on Medical Assistance or MinnesotaCare seeking coverage for transition services, including transition-related surgery. OutFront provides guidance to these individuals regarding Minnesota’s Medical Assistance program and their coverage options.
“Since its inception nearly 30 years ago, OutFront Minnesota has been firmly committed to advancing transgender equality across Minnesota,” said Monica Meyer, executive director of OutFront. “In recent years, we have undertaken a comprehensive approach to eliminating unjust barriers to health care that many transgender people face. Today's lawsuit is a critical part of this effort, and we thank the ACLU and Dorsey & Whitney for their steadfast support for achieving the equal protection of law for Minnesota's transgender community.”
Ten states and the District of Columbia currently cover transition-related surgical care through their public health insurance programs. Transition-related surgery is also covered by Medicare.
The case is filed against the Commissioner of Minnesota’s Department of Human Services, and it demands that Minnesota end its discriminatory practice of excluding transgender individuals from accessing all of their needed health care.
Cooperating attorneys in the case include Kristina Carlson, David Couillard, and JoLynn Markison of Dorsey & Whitney; Teresa Nelson of the ACLU-MN; and Joshua Block of ACLU.
LGBTQ Rights
OutFront v. Johnson Piper
LGBTQ Rights
OutFront v. Johnson Piper
Learn More About the Issues in This Press Release
-
Press ReleaseDec 2024
LGBTQ Rights
President Biden Must Veto Defense Bill Attacking Military Families with Transgender YouthPresident Biden Must Veto Defense Bill Attacking Military Families with Transgender Youth
WASHINGTON — The U.S. Senate today passed a version of the National Defense Authorization Act that would ban coverage for gender-affirming care for transgender youth whose parents are active-duty military personnel. The American Civil Liberties Union is opposing final passage of the defense bill over the inclusion of this health care ban and calling on President Joe Biden to veto the bill. Section 708 of the NDAA would prohibit insurance coverage for “medical interventions for the treatment of gender dysphoria” such as hormone therapy and puberty-suppressant medications, which Speaker Mike Johnson says would “permanently ban transgender medical treatment for minors.” The same treatments would be covered by TRICARE for any medical purpose other than treating gender dysphoria, the clinical diagnosis for the psychological distress experienced by transgender people related to their gender identity. “By passing this bill, the House and Senate are forcing thousands of active-duty service members to choose between their careers in the military and the future of their transgender children,” said Mike Zamore, national director of policy & government affairs at the ACLU. “This unconscionable and unjustifiable attack on those families stands in direct contrast to President Joe Biden’s legacy of defending the civil rights of transgender Americans — including when few in his own party showed the courage to do so. President Biden should cement his legacy by vetoing this bill and sending it back to Congress to pass without Speaker Johnson’s last minute health care ban for servicemembers’ kids.” If signed by President Biden, this health care ban would be the first new anti-LGBTQ provision enacted by Congress and signed into law by the president since the enactment of the military’s since-repealed “Don’t Ask, Don’t Tell” policy for LGBTQ servicemembers and the since-repealed federal law barring recognition of same-sex marriages known as the Defense of Marriage Act. It is unknown how many transgender youth are currently enrolled in TRICARE or how many of those enrolled are currently receiving coverage for gender-affirming care. In one 2022 analysis, 2,500 minor patients sought care for gender dysphoria through TRICARE Prime insurance at military or civilian treatment facilities in 2017, and 900 received puberty suppressants or gender-affirming hormones. Earlier this month, the Supreme Court heard oral arguments in a landmark case brought by the ACLU, the ACLU of Tennessee, Lambda Legal, and Akin Gump on behalf of three families and a medical provider challenging a Tennessee ban on gender-affirming hormonal therapies for transgender youth on the grounds the ban violates the Equal Protection Clause of the U.S. Constitution. -
Press ReleaseDec 2024
LGBTQ Rights
Montana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's LicensesMontana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's Licenses
HELENA, Mont. – A Montana court has granted a preliminary injunction preventing the state of Montana from enforcing policies that bar transgender people from obtaining accurate sex designations on their birth certificates and driver’s licenses. After a prior restriction on amendments of birth certificates was struck down by the courts, in early 2024 the state of Montana enacted a new rule that categorically bars transgender Montanans from correcting the sex designation on their birth certificates. Around the same time, the Montana Department of Justice adopted a policy similarly restricting amendment of driver’s licenses. The plaintiffs challenged these policies in state district court, arguing that they violate various constitutional provisions, including the right to equal protection of the law. In a recent Montana Supreme Court decision, two justices concluded that discrimination on the basis of transgender status – as the state is engaging in here – is a form of sex discrimination that violates the Montana Constitution’s equal protection clause. The plaintiffs, two transgender women, are represented by the American Civil Liberties Union, the ACLU of Montana, and Nixon Peabody LLP. Plaintiff Jessica Kalarchik, a veteran who served in the United States Army for 31 years, said: “After finally being able to live my life openly as the woman I know myself to be, I am frustrated that my birth state, Montana, wants me to carry around a birth certificate that incorrectly lists my sex as male. I live my life openly as a woman, I am treated as a woman in my daily life, and there is no reason I should be forced to carry a birth certificate that incorrectly identifies me as male. Fortunately, the court agrees that this ridiculous policy should not be in effect.” “Once again the State of Montana chose to adopt a draconian policy that is clearly intended to marginalize transgender Montanans, only for that discriminatory action to be blocked by the courts,” said Akilah Deernose, executive director for the ACLU of Montana. “Here in Montana we treasure our right to privacy and to live our lives free from governmental intrusion. The State of Montana clearly has not learned any lessons from the past few years, where courts have repeatedly struck down unconstitutional laws targeting transgender Montanans.” “Forcing anyone to carry documents that contradict their identity unjustly violates their rights to privacy, equal treatment, and not being compelled to convey a government message about their sex that they disagree with,” said Malita Picasso, staff attorney for the ACLU’s LGBTQ & HIV Project. “Such a policy marks transgender people for further mistreatment and discrimination, essentially requiring them to carry papers that out them as transgender any time they need to provide identity documents. Fortunately, the court has refused to allow the state of Montana to subvert the freedom of transgender Montanans to control their own identity as this case goes forward.” In granting the plaintiffs’ motion for a preliminary injunction, the court held, “[i]f the challenged state actions discriminate against transgender individuals on the basis of their transgender status, they also necessarily discriminate the basis of sex.” The state has the option of appealing the district court’s ruling to the Montana Supreme Court, but the underlying case will proceed in district court. A trial has not yet been scheduled. -
FloridaDec 2024
LGBTQ Rights
Keohane v. DixonKeohane v. Dixon
On September 30, 2024, the Florida Department of Corrections rescinded its policy regarding treatment of gender dysphoria, which allowed for hormone therapy when deemed medically necessary, as well as access to clothing and grooming standards that accord with one’s gender identity. Under this new policy, grooming and clothing accommodations have been stripped away, and hormone therapy is not permitted unless an exception is deemed constitutionally required. The ACLU brought a class action challenging the policy. -
IdahoDec 2024
LGBTQ Rights
Robinson v. LabradorRobinson v. Labrador
Two incarcerated transgender women have sued the state of Idaho alleging that HB 688, a 2024 law barring state funding for gender-affirming medical care for transgender people, denies them access to the health care their doctors have prescribed for them and is a violation of their Eighth Amendment right to be free from cruel and unusual punishment. They represent a class of all incarcerated folks within the state of Idaho who face the loss of hormone therapy due to HB 668.