Judge rules Wisconsin cannot exclude transgender surgeries, hormone treatments from Medicaid coverage

A federal judge ruled Friday that Wisconsin cannot exclude so-called gender-reassignment treatments, including both surgery and hormones, from coverage under the Medicaid program, striking down a rule that’s been on the books for decades.

U.S. District Judge William Conley was hearing a case brought by four gender-confused Medicaid patients against a 1997 Department of Health Services administrative provision that excluded “transsexual surgery” from Medicaid. In a 38-page opinion, Conley ruled that excluding the treatments constitutes sex discrimination under the federal Affordable Care Act (Obamacare), the Capital Journal reports.

photo John Hain

“There is now a consensus within the medical profession that gender dysphoria is a serious medical condition, which if left untreated or inadequately treated can cause adverse symptoms, such as anxiety, depression, serious mental distress, self-harm and suicidal ideation,” he wrote, adding that insurance companies currently managing state HMO Medicaid plans “acknowledge that gender-confirming hormone and surgical treatments for gender dysphoria can be medically necessary.”

Wisconsin’s Medicaid system has an estimated $9.7 billion budget and 1.2 million enrollees, approximately 5,000 of whom are believed to have some form of gender confusion. The state says covering surgery for all of them could cost taxpayers as much as $2.1 million, and contends that transgender surgery has no proven medical benefit.

Last year, Conley issued a temporary injunction barring the state from enforcing the rule against two of the plaintiffs. Wisconsin is one of nine states that excludes gender-transition treatment from Medicaid.