A federal lawsuit was filed last week seeking to eliminate the state Medicaid program’s ban on covering treatments for gender dysphoria.
The named defendant is Theodore Dallas, secretary of the state’s Department of Human Services.
Medicaid is a health-care program for low-income individuals that receives state and federal funds. But many states, including Pennsylvania, won’t allow their Medicaid program to funds treatments for gender dysphoria.
Those treatments include gender-confirmation surgery, hysterectomy, hormonal therapy, breast reconstruction, penectomy, vaginoplasty, mastectomy, vaginal dilation and release of labial adhesions.
Advocates say the gender-dysphoria exclusion discriminates against the transgender community, in violation of federal laws.
The Feb. 18 lawsuit was filed on behalf of “John Doe,” 30, a Delaware County trans man with gender dysphoria. Doe has received Medicaid benefits since 2013. He seeks a hysterectomy, but the state’s Medicaid program refuses to pay for one.
In July 2015, Doe’s physician submitted a request on Doe’s behalf for Medicaid coverage for a total abdominal hysterectomy. The request was denied by Keystone First Health Plan, one of the state’s designees for administering the Medicaid program in Southeastern Pennsylvania.
Doe appealed the denial, and on Oct. 26, 2015, an administrative-law judge denied Doe’s appeal, citing the gender-dysphoria exclusion in the state’s Medicaid rules.
“Doe’s untreated GD has led to his constant suffering and emotional distress,” the lawsuit states. “He is unemployed and has other issues, due in part to his untreated GD. Immediate and medically-necessary GD treatment should be provided to [Doe] in accordance with the Constitution and laws of the United States.”
The lawsuit goes on to note that “other Medicaid eligible individuals who have not been diagnosed with GD and have been prescribed a medically necessary hysterectomy will receive Medicaid coverage for a hysterectomy and associated medically necessary procedures and services.”
The lawsuit claims the gender-dysphoria exclusion violates the equal-protection and supremacy clauses of the Constitution, the Medicaid Act, and the Affordable Care Act.
The lawsuit also notes that Pennsylvania state-government employees are provided health-care coverage that includes treatments for gender dysphoria.
“The Commonwealth’s actions banning such coverage to Medicaid eligible individuals diagnosed with GD — while at the same time the Commonwealth furnishes health-insurance coverage to Commonwealth employees with GD — discriminates against [Doe], without any rational basis for such conduct,” the lawsuit alleges.
The lawsuit seeks a judicial order for the state to lift the gender-dysphoria exclusion in its Medicaid program, and for Doe to be provided Medicaid coverage for all health-care services necessary to treat his GD.
The lawsuit also seeks punitive and compensatory damages, along with reasonable attorney’s fees.
The case has been assigned to U.S. District Judge J. Curtis Joyner.
Julie Chovanes, an attorney, trans woman and executive director of Trans Help, filed the lawsuit on behalf of Doe.
“I’m humbled and gratified to attempt to vindicate my client’s rights, and in the process, give hope to thousands of other Medicaid-eligible trans Pennsylvanians who are disenfranchised from the system,” Chovanes said. “I’m optimistic the state will realize the error of its ways and do what’s right. But if it doesn’t, we are prepared to vigorously pursue this matter in court.”
She said the lawsuit has the potential of benefiting numerous trans Pennsylvanians with gender-dysphoria.
“If we get a declaration that the state Medicaid program’s ban on treatments for GD is discriminatory, my client wins, the ban is eliminated, and it paves the way for all other Medicaid-eligible trans Pennsylvanians diagnosed with GD to receive medically-necessary treatments,” she said.
A spokesperson for DHS declined to comment for this story, referring the matter to Gov. Wolf’s office.
Wolf spokesperson Jeffrey Sheridan issued the following statement:
“The Pa. Code precludes coverage through Medicaid for gender confirmation medical care and surgical procedures. Governor Wolf believes this is wrong. Pennsylvania should not discriminate against any individual based on sexual orientation and gender identity and expression. The governor hopes to have a robust conversation with the legislature, community and all other parties regarding this issue to move the Commonwealth forward.”
Dr. David M. Jaspan, chair of the department of Obstetrics and Gynecology at Einstein Medical Center in Philadelphia, voiced support for the lawsuit.
“We know the health-care industry is actively in the process of reviewing care practices specifically for transgender individuals and we hope that this recent development will further encourage those discussions,” Jaspan said in an email. “In the meantime, at Einstein Healthcare Network, we stand ready to provide quality, compassionate care to all those in need, as we always have.”