State sued over transgender health benefits
Two transgender state employees who have been denied medical treatment for gender dysphoria filed a federal lawsuit Monday against the Florida Department of Management Services alleging unlawful sex discrimination.
The lawsuit, filed on behalf of Jami Claire and Kathryn Lane by attorneys for Southern Legal Counsel, Inc., and the ACLU Foundation of Florida, seeks compensatory damages and an injunction banning the state from enforcing an exclusion in the state employees’ health-insurance plan for coverage of medically necessary gender-affirming care.
“I’m hoping this policy gets changed so we all have a choice to use our medical policies that we pay for just like everybody else does,” Claire told The News Service of Florida. “Why should we be limited in how we use our medical policies just because we are transgender? That’s the only reason we are being stopped is because we are transgender. That’s it.”
The Department of Management Services, which administers the state-employee health insurance program, did not immediately reply to requests for comment.
Claire has worked for 32 years at the University of Florida, where she is a senior biological scientist in the College of Veterinary Medicine. Claire has officially identified as a transgender woman since Dec. 24, 2016, after a friend took her bra shopping for the first time.
“It was a pretty good Christmas present,” she recalled.
But it’s been a long and emotional journey for the 62-year-old, who first learned about gender-affirming options in 1975 when she was 17.
Claire first started to transition in 1997, taking hormones and undergoing electrolysis. But she said she “called it off” in 2002 after becoming aware of the exclusion in the state health plan.
Between 2002 and 2016, Claire said, “life was not really very good.”
She said she tried on three different occasions to commit suicide. She also mutilated herself five times during that period.
“I detest what I have between my legs,” she said. “I’ve tried to remove them multiple times.”
Claire changed her legal name and gender marker in 2017, updating her Social Security card, drivers’ license, passport and discharge papers from the U.S. Navy where she served more than six years.
She paid out of pocket for a breast augmentation in 2018 to continue to feminize her body.
Gender dysphoria is a condition that involves discomfort or distress caused when people identify with genders that are different from their biology. If left untreated, gender dysphoria can cause distress, depression, anxiety and self-injurious behavior.
Claire receives counseling — and hormones — from the U.S. Veterans Administration But the level of hormones she is taking places her at risk of deep vein thrombosis, or a blood clot that forms in the lower body.
Due to that risk, her physician recommended an orchiectomy, or surgical removal of the testes, as a medically necessary procedure on Dec. 27, 2018.
But, according to the lawsuit, AvMed, an insurer in the state plan, denied the request Jan. 8, 2019, citing the exclusion for gender reassignment or modification services or supplies. She unsuccessfully appealed the denial to AvMed and then to the department’s Division of State Group Insurance.
“Had the requested surgery been recommended by a medical provider for a medically necessary purpose other than treatment for gender dysphoria — for instance, an orchiectomy for an individual suffering from testicular cancer or trauma to the testes — the state plan would have covered it,” the lawsuit said.
In addition to naming the department and its secretary, Jonathan Satter, as defendants, the lawsuit also names as defendants the University of Florida Board of Trustees and Andy Thomas, public defender of the 2nd Judicial Circuit, where Lane works as a public defender.
Lane, 39, started counseling for gender dysphoria and began undergoing electrolysis and started taking hormones. In 2015 she began growing out her hair and asked the state about breast augmentation mammoplasty but was told that it wasn’t a covered benefit. As a result, she paid out of pocket for the expense.
Despite taking hormones for seven years, Lane’s facial structure remains “phenotypically male,” the lawsuit said. Her physician recommended facial feminization surgery as medically necessary treatment for her gender dysphoria. The request was denied by Capital Health Plan, another insurer in the state plan, on Feb. 19, 2019.
She appealed the denial but, according to the lawsuit, Capital Health Plan upheld the original decision, citing the exclusion and adding “cosmetic surgeries/services” as an additional basis for the denial.
“Despite her intentionally feminine presentation, Ms.Lane’s facial features can still be identified as masculine, which causes her significant anxiety, depression, and psychological distress, in addition to putting her at risk for violence, harassment and discrimination,” the lawsuit alleges. “Transgender women face violence, harassment, and discrimination at disproportionately high rates, and there are transgender women murdered in Florida every year because they are transgender. Ms. Lane lives in fear of such interactions as a result of having facial features that can be identified as masculine and that ‘out’ her … to strangers without her consent or volition.”
The state health-insurance program covered more than 366,000 employees and dependents as of June 2019.
Southern Legal Counsel attorney Simone Chriss said gender-affirming medical care is covered by private insurance programs and the majority of Fortune 500 companies.
She said there are many cases across the country establishing that transgender exclusions in health insurance plans are arbitrary, discriminatory and unlawful.
“If Florida won’t voluntarily join the right side of history, we will gladly facilitate that journey,” Chriss said in a prepared statement.