Georgia to Include gender-affirming surgery in state’s Medicaid program

The American Civil Liberties Union, the ACLU of Georgia, and the law firm of King & Spalding has settled a lawsuit with the Georgia Department of Community Health over its categorical exclusion of coverage for gender-affirming surgery in the State of Georgia's Medicaid program. The settlement in Thomas et al. v. Georgia Department of Community Health et al. means that transgender Georgia Medicaid beneficiaries living with gender dysphoria can now access lifesaving, gender-affirming surgical care.

As part of the settlement, the Georgia Department of Community Health agreed to remove the exclusion for gender-affirming surgery from Georgia Medicaid and, like all other medical care provided in the program, provide the care when it is medically necessary for an individual. It further agreed to adopt benefits and clinical guidelines for the treatment of gender dysphoria, including benefits for gender-affirming surgical care.

"Gender-affirming surgeries are safe, effective, and medically necessary," said Taylor Brown, staff attorney with the ACLU LGBTQ & HIV Project. "The ability to obtain gender-affirming surgical care, regardless of socioeconomic status, is an important factor in eliminating systemic health disparities and inequities that many transgender people face. This settlement brings the state of Georgia's Medicaid program in line with the accepted standards of care and the law. The removal of the exclusion of benefits, that are already available for cisgender beneficiaries, for transgender Georgia Medicaid beneficiaries in need of gender-affirming care will save lives."

"Denying necessary health care because an individual is transgender is discriminatory and unconstitutional," said Nneka Ewulonu, staff attorney with the ACLU of Georgia. "This settlement will give low-income transgender Georgians on Medicaid--who are disproportionately likely to be Black--access to gender-affirming care for the first time in over 20 years. We are thrilled for our clients and the transgender community in Georgia."

The lawsuit was filed June 24, 2021 on behalf of Delshone Thomas and Gwendolyn Cheney, transgender women and Georgia Medicaid beneficiaries who were denied gender-affirming surgical care for the treatment of gender dysphoria. The lawsuit challenged Georgia's ban on gender-affirming surgeries as being in violation of the U.S. Constitution, the Affordable Care Act, and the federal Medicaid Act. The lawsuit was settled April 26, 2022 following court-facilitated mediation in the U.S. District Court for the Northern District of Georgia.

"LGBTQ people face immense difficulties accessing affordable health care," said Eric Paulk, deputy director of Georgia Equality, a nonprofit that advances fairness, safety and opportunity for lesbian, gay, bisexual, and transgender communities. "This is especially true for Black transgender and gender-diverse individuals. By expanding access to gender-affirming surgery and other treatments for people who rely on healthcare coverage through Medicaid, we begin to chip away barriers to care. We know that gender-affirming care is medically necessary care. This settlement moves us closer to more equitably delivered health care in Georgia."

While the actual removal of the exclusion from the Georgia Medicaid State Health Plan will take a few months, transgender Georgia Medicaid beneficiaries should now be able to apply for coverage of gender-affirming surgical care through their providers. It is important that either Georgia Medicaid beneficiaries or their providers obtain the clinical guidelines for the treatment of gender dysphoria from Georgia Medicaid to ensure eligibility criteria has been met and all required documentation is submitted.

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Original text here: https://acluga.org/aclu-of-georgia-announces-settlement-with-georgia-to-include-gender-affirmingsurgery-in-states-medicaid-program/