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ACLU sues MN over lack of health coverage for transgender surgery


The American Civil Liberties Union is suing the state of Minnesota because its public health insurance programs do not cover gender reassignment surgery.

The ACLU and the ACLU of Minnesota filed a lawsuit in Minnesota State Court, challenging the coverage ban on transition-related surgery for low-income transgender people on the state's Medical Assistance and MinnesotaCare programs.

In a press release, the ACLU says Medical Assistance "provides coverage for medically necessary care for virtually every type of medical condition," but features a "sweeping and categorical exclusion" for all necessary surgical care relating to gender dysphoria.

This coverage is denied even though the federal Medicare program covers all medically necessary gender reassignment surgery, while the ACLU says that private insurance plans regulated by Minnesota also offer coverage.

A Minnesota Department of Human Services spokesperson told BringMeTheNews: "We have received the lawsuit, which challenges current state law. We are now reviewing the complaint."

What is gender dysphoria?

The National Institute of Health's U.S. Library of Medicine says gender dysphoria is when there's a "conflict" between someone's physical gender traits, and the gender they identify with.

WebMD says people with gender dysphoria feel strongly they are not the gender they physically appear to be. It notes that the condition can lead to "severe distress, anxiety and depression."

It's often treated with therapy to help those with the condition address mental health issues (such as those listed above,) with hormone treatments and surgery potentially following for those who wish to develop the traits of the gender they identify as.

The U.S. Library of Medicine says recognizing and treating the condition early "can reduce the chance of depression, emotional distress, and suicide."

Depression rates among transgender people are significantly higher than the rest of the population.

According to a study by The Williams Institute, the rate of suicide attempts among trans or gender non-conforming people is 41 percent, compared to between 10-20 percent for lesbian, gay or bisexual people, and 4.6 percent among the overall population.

"Arbitrarily denying necessary heath care services to a segment of the population is harmful and discriminatory,” Teresa Nelson, legal director of the ACLU-MN, said. "Transgender people deserve access to transition-related surgery that is a medical necessity and recognized as such by every major medical organization."

Plaintiff says denial is harming their health

The ACLU says the complaint was filed on behalf of plaintiffs Evan Thomas and LGBTQ rights group OutFront Minnesota.

Thomas is currently on Medical Assistance and was diagnosed with gender dysphoria, having fought against depression all his life. He started hormone therapy and legally changed his name and gender earlier this year, but has been denied coverage for his transition surgery.

"A weight was lifted when I first began my gender transition and realized I didn't have to pretend to be a woman anymore," he told the ACLU. "Being denied surgical treatment is harmful to my health and well-being every day I'm forced to live in this body."

Health insurance company Aetna has a list of criteria that transgender people must meet in order for their reassignment surgery to be considered "medically necessary."

Anyone who wants full reconstructive surgery needs two referral letters from mental health professionals, "persistent and well-documented dysphoria," and needs to have been living as their desired gender and undergone hormone therapy for the past 12 months.

Push to improve transgender health rights

Earlier this year, The Column reported DFL lawmakers proposed a bill in the the Minnesota Legislature that would lift the ban on gender reassignment surgery deemed medically necessary. The bill has since been sent to committee for further discussion.

The Column notes that gender reassignment surgery was covered in Minnesota up until 2005, when a health and human services omnibus bill that blocked coverage was passed.

It comes amid a broader push by the Obama administration for more accessibility to healthcare for transgender people.

The Huffington Post reported in September that new regulations are being pushed that would forbid health insurance companies from excluding gender transition treatments. They would give transgender people the legal right to make civil rights claims against insurers, doctors and hospitals who deny coverage or necessary care.

It follows a survey in which four out of 10 transgender people said they'd experienced discrimination in the health care system.

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