Suit: Georgia Medicaid should cover gender-affirming surgeries

ATLANTA — Two Georgians have filed a lawsuit saying their constitutional rights were violated when the state Medicaid program declined to cover the gender-affirming surgeries they say they need to live a full life.

At issue is whether the reconstructive or plastic surgeries sought by Shon Thomas and Gwendolyn Cheney are a matter of medical necessity.

Georgia Medicaid guidelines “incorrectly characterizes their gender-confirming health care needs as ‘cosmetic’ and/or ‘experimental or investigational,’ when the medical community recognizes that they are effective treatments for gender dysphoria,” attorneys for the American Civil Liberties Union said in suit filed on behalf of the transgender women.

Gender dysphoria is when one’s biological sex and gender identity do not align, leading to psychological distress, according to the American Psychiatric

Association. Common transgender surgery options include facial reconstructive surgery to make features more masculine or feminine, or procedures on the chest or genitals, according to the Cleveland Clinic.

The ACLU is arguing that, by not covering those procedures, Georgia’s Medicaid program is violating the U.S. Constitution, the Affordable Care Act and the Medicaid Act.

Around a dozen states explicitly ban coverage of gender-affirming care under Medicaid, a program that offers assistance to people who can’t afford to pay for medical care. Georgia’s ban is focused on gender-affirming surgeries. Hormone treatments and psychological services are covered, said ACLU staff attorney Taylor Brown, who is taking the lead in the case.

“Gender-affirming health care is essential health care,” said Eric Paulk, the deputy director of nonprofit Georgia Equality. “The state’s refusal to cover essential and often life-saving gender-affirming health care is discrimination, full stop.”

Roughly 0.75% of adults in the state —55,650 — identify as transgender, the fourth highest percentage in the nation, according to a 2016 UCLA School of Law study. About 5,000 are on Medicaid, the ACLU says.

Thomas, 45, who lives in metro Atlanta, said both her doctor and psychiatrist have recommended surgeries.

“This is a battle I have been dealing with all my life,” Thomas said. “First, I didn’t have support from my family; now, it is Medicaid. I had to overcome the trials and tribulations with my family, and I am hoping that I can be successful with Medicaid.”

The ACLU has filed similar suits in two other states.

In Georgia, the organization partnered with King & Spalding. Named as defendants are the state Department of Community Health, which administers Medicaid, and its commissioner. A spokeswoman for the Georgia DCH declined to comment, citing the ongoing litigation.