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Arizona is one of ten states that bans transgender-specific health coverage for people on Medicaid.
Two transgender teenagers last week filed a lawsuit to challenge Arizona’s categorical ban on transgender surgeries for Medicaid recipients, saying the state’s refusal to cover surgeries recommended by doctors as medically necessary amounts to a violation of their civil rights.
The two teens, named D.H. and John Doe in the suit, are both transgender boys whose doctors say they need chest reconstruction surgery to treat gender dysphoria, the medical term for those whose gender identities do not align with their sex assigned at birth. Gender dysphoria is “a serious medical condition that, if left untreated, can cause anxiety, depression, and even self-harm or suicidal ideation,” the lawsuit states.
Seventeen-year-old plaintiff D.H. said that because he was denied surgery, he wears a chest binder, a compression garment that reduces the appearance of breasts. “Wearing the binder for any extended period of time is painful,” he said in a statement. “The binder is so tight that I cannot breathe fully, making it impossible to be physically active and do the things I love, like dance and theater. That has taken a serious toll on my mental health and I have struggled with severe depression and anxiety as a result of being denied needed care.”
Both plaintiffs in the suit say they started receiving treatment for gender dysphoria around the time they began going through puberty, as often happens for transgender people. The physical changes arising from puberty can make “even basic daily tasks, such as bathing and getting dressed … emotionally paralyzing because those tasks are painful reminders of the disconnect between a transgender young person’s body and their gender identity,” the suit says.
The suit is a class-action on behalf of Arizona Medicaid recipients under age 21 who seek medically necessary chest reconstructive surgery for treatment of gender dysphoria, a group that the suit estimates contains at least a hundred people.
Arizona is one of ten states that has a state Medicaid policy explicitly banning transgender health care, along with states like Texas, Ohio, Missouri, and Georgia. Twenty-two states and the District of Columbia have explicit policies covering transgender care, and 18 have no policy. The Arizona policy at issue dates back to 1982, according to the lawsuit.
Major medical groups including the American Medical Association, the American Psychological Association and the American Academy of Pediatrics have recommended that transgender youth have access to a wide range of medical interventions, including counseling, hormone replacement therapy and surgery.
But despite the backing of medical organizations, Rodrigo Heng-Lehtinen, deputy director for the National Center for Transgender Equality, said that health care for transgender people “is often stigmatized and misunderstood.”
“Medically necessary transition-related care is overwhelmingly recognized by medical experts as effective and necessary for many transgender people,” Heng-Lehtinen said. “Transition-related health care is health care and shouldn’t be treated differently than other medically necessary treatments."
This is not the first time that policies like the one in Arizona have been challenged in the courts. When Iowa’s policy banning state funds from being used for transgender health care was taken to court in 2019, the state Supreme Court ruled that the ban violated the state’s civil rights laws after deeming gender affirming surgery medically necessary. That ruling has since resulted in a continued legal battle in that state, as two months later, Gov. Kim Reynolds signed a law that allows state-funded insurance providers to deny coverage for transgender care. The Iowa Court of Appeals dismissed a challenge to that law filed by the American Civil Liberties Union, finding that the plaintiffs had failed to go through the necessary step of requesting Medicaid coverage for surgery.
The lawsuit in Arizona, filed in federal district court, alleges that the state’s ban violates the Medicaid Act, the Affordable Care Act’s anti-discrimination provisions, and Fourteenth Amendment’s equal protection clause. The suit also argues that the policy banning gender affirming surgeries has “no medical or scientific basis” because the state covers similar surgeries in other contexts, such as breast reconstruction after mastectomies.
A representative from Arizona’s Medicaid program, known as the Arizona Health Care Cost Containment System, said that the agency has “received notification of the lawsuit but cannot provide further comment on pending litigation.”
Emma Coleman is the assistant editor for Route Fifty.