Nonprofit Sues GA for Refusing to Cover Transgender-Related Healthcare

The Transgender Legal Defense and Education Fund (TLDEF) has filed a lawsuit against the state of Georgia for denying coverage of transgender-related healthcare for members of the Georgia State Health Benefit Plan (SHBP).

SHBP provides health insurance coverage for more than half a million Georgia residents, including state employees, teachers, public school employees, retirees, and their family members.

The lawsuit plaintiffs include Micha Rich and Benjamin Johnson, two employees of Georgia government agencies who are being denied transgender-related healthcare services, and the Campaign for Southern Equality (CSE), a nonprofit organization centered around advancing LGBTQ+ civil rights in the South.

SHBP members Jane Doe, an employee of the Division of Family and Children Services, and her young adult child John Doe, are also plaintiffs.

Rich is a staff accountant at the Georgia Department of Audits and Accounts, while Johnson is a media clerk at an elementary school in Bibb County. Both plaintiffs have been diagnosed with gender dysphoria, which the World Professional Association for Transgender Health (WPATH) says can be treated with social and medical gender transition.

“Time and again, courts have ruled that denying healthcare to people because they are transgender is not only clearly wrong – it is also clearly illegal,” David Brown, legal director for TLDEF, said in a press release emailed to HealthPayerIntelligence. “We had a landmark victory on this exact question just a few months ago, and we are confident that the courts will once again come to the right decision – that there is no room for discrimination in Georgia.” 

In June 2022, a Georgia federal district court ruled that an employer cannot exclude or deny coverage for transition-related medical treatments from its employee health insurance plan. In addition, after being sued in a federal case, the state of Georgia ended its exclusion of transgender-related healthcare in its Medicaid plan.

“Far too often, government institutions and extremist forces discriminate against transgender people by limiting our access to necessary healthcare,” said Holiday Simmons, director of healing and resilience for CSE. “When governments intervene in the conversations that should be between a medical provider and a patient, it harms us, it limits our treatment options, and it’s wrong.”

CSE launched the Southern Equality Fund (SEF) in 2015, which provides $250 in emergency assistance grants to LGBTQ southerners. Recipients can use the money for basic needs, including prescriptions, medical bills, groceries, and rent or mortgage payments.

SHBP members have requested grants from CSE to help cover out-of-pocket expenses for transition-related medical treatments that are not covered by the health plan or to cover other costs that they cannot afford due to a lack of coverage for this care.

Medicare, Medicaid, and many private employers and health plans recognize transgender-related care as medically necessary. Additionally, the American Medical Association, American Psychiatric Association, and American Psychological Association support insurance coverage for gender-affirming care.

LGBTQ+ populations face significant disparities in accessing healthcare, especially transgender individuals.

Aside from health plans denying transgender-related healthcare to members, past research has found that a shortage of providers willing to treat or knowledgeable about treating transgender people was a primary barrier to care.

Mental healthcare access has also been a struggle for this population. Almost three in five transgender or nonbinary kids reported wanting or needing mental healthcare in the past year but were unable to access it, according to data from the Trevor Project.

Further, 93 percent of transgender and nonbinary youth said they have worried about transgender people being denied access to gender-affirming care due to state or local laws.

Data from MACPAC also found that experiences for transgender individuals differed depending on their health insurance type. For example, transgender and gender-diverse people covered by Medicaid were more likely to report severe psychological stress and higher rates of substance abuse, suicidal ideation, and attempted suicide than privately insured individuals.