Georgia Can No Longer Deny Coverage for Transgender Care
Georgia agrees to remove discriminatory language from employee health care plans, ensuring coverage for gender-affirming treatments.
The state of Georgia settled a lawsuit brought by a transgender advocacy group challenging an exclusion in the Georgia State Health Benefit Plan that denies coverage for transition-related treatments.
On Thursday, the state reached a settlement with the Transgender Legal Defense and Education Fund on behalf of three state employees who were denied coverage for treatments for themselves or their dependents, according to a TLDEF press release.
Two of the plaintiffs — Micha Rich, a staff accountant at the Georgia Department of Audits and Accounts, and Benjamin Johnson, a media clerk at an elementary school in Bibb County, Georgia — are transgender men who have been diagnosed with gender dysphoria and were advised to pursue social and medical transition to treat their dysphoria.
The third plaintiff, referred to by the pseudonym “Jane Doe,” is an employee of the state’s Division of Family and Children’s Services, whose adult transgender son, “John,” gets his insurance coverage through his mother’s plan.
In all three instances, the plaintiffs were denied coverage for gender confirmation surgery. Rich and John Doe were also denied coverage for hormone therapy — even though such treatments are offered to non-transgender patients if recommended by their doctors — because they would assist in a gender transition, violating the state employee insurance plan’s prohibitions on coverage for transition-related treatments.
As a result of the denials of coverage, all three trans individuals had to forego surgery for a significant period — in Rich’s case, two full years.
Rich and Doe ultimately had to pay out of pocket to cover the cost of their surgical and hormonal treatments, with Rich being forced to declare bankruptcy a few months later due to the financial strains placed on him.
Johnson was able to have his surgery covered by switching to a non-discriminatory Marketplace plan, which he had to pay for out of his own pocket.
Under the terms of the settlement, the members of the State Health Benefit Plan, including state employees and their dependents, will now be able to obtain coverage for gender-affirming treatments, effective immediately. Georgia has also agreed to pay $365,000 in total to the plaintiffs in the case, including Rich, Johnson, Jane Doe, John Doe, and the Campaign for Southern Equality, a nonprofit LGBTQ advocacy organization.
The money will cover some of the costs incurred as a result of the denial, including legal expenses associated with filing the lawsuit.
For the Campaign for Southern Equality, it will help cover the costs of grants that the organization doled out to transgender individuals, including some State Health Benefit Plan beneficiaries, to help them defray the out-of-pocket costs of pursuing gender-affirming care without insurance coverage.
The settlement also directs all insurance plans offered by State Health Benefit Plan to immediately add provisions clarifying that transgender health care coverage includes any medically necessary surgical or hormonal interventions recommended by a patient’s primary provider.
The revision to the plans will also remove language prohibiting insurance dollars from being used for gender-affirming treatments.
Additionally, Georgia is prohibited from attempting to craft similar insurance exclusions at any time in the future.
The settlement is timely, as open enrollment — the period during which individuals either renew their existing insurance coverage or choose to seek out better plans elsewhere — is currently underway for Georgia state employees, who must determine whether their plans provide them with sufficient coverage for treatments they may need.
The settlement also follows a June 2022 ruling in which a Georgia federal district court ruled in favor of a transgender sheriff’s deputy who was denied coverage for transition-related medical treatments under an exclusion in its employee health insurance plan — the first such ruling of its kind in the South.
The plaintiffs in the case celebrated the news of the settlement.
“I am thrilled to know that none of my trans colleagues will ever have to go through what I did,” Rich said in a statement. “I hope this is a new day for my beloved state of Georgia in its treatment of trans and nonbinary people.”
“When I was able to get the medical treatment I needed, I finally felt whole. I feel like this is the person I was meant to be, and my mental health has improved drastically,” Johnson said in a statement.
“In a year when transphobic extremists have pushed restriction after restriction for transgender people’s access to necessary health care, a development like this that will enable transgender Georgians to more easily access care is a huge victory,” Holiday Simmons, the director of healing and resilience for the Campaign for Southern Equality, said in a statement.
“No government should be inserting itself into residents’ private medical decisions, and we’re encouraged to see that transgender people who are state employees in Georgia will no longer be denied coverage for life-affirming and even life-saving health care.”
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