Three Alaskans are challenging the legality of a rule in the state’s Medicaid program that excludes transgender Alaskans in the program from coverage for transition-related health care.
Swan Being, Robin Black and Austin Reed are suing Alaska Department of Health and Social Services Commissioner Adam Crum and the department, arguing that the exclusion is a civil rights violation.
The lawsuit is an amended version of one filed last year. The parties are now in discussions in hopes of reaching a settlement.
Alaska is one of 10 states with a Medicaid program that explicitly excludes this type of coverage.
“Not only do the (state) regulations discriminate on the basis of sex, they also lack any rational basis," the lawsuit states. “The regulations fly in the face of the medical consensus that gender-confirming medical care is the only safe and effective treatment for gender dysphoria.”
Gender dysphoria is classified by the Diagnostic and Statistical Manual of Mental Disorders as “the clinically significant distress or impairment in social, occupational, or other areas of function associated with the incongruence between a transgender person’s gender identity and assigned sex."
The lawsuit describes incidents where the three plaintiffs sought care and were told Alaska Medicaid would not cover it.
Being is a 71-year-old Homer woman who has been medically diagnosed with gender dysphoria and has been living as a woman for more than five years, according to the lawsuit.
Although her doctors have recommended she continue to receive medical treatment related to her hormone levels, the lawsuit states she received a notice from a contractor for the state that said “hormonal injections and lab work associated with gender reassignment is not a covered benefit under Alaska Medicaid."
Black and Reed report similar experiences in the lawsuit: Both were denied coverage for different surgical procedures meant to treat their diagnosed gender dysphoria, their attorneys wrote in the lawsuit.
In February 2020, Crum proposed a change to state Medicaid regulations that would “(a)llow Medicaid coverage for non-surgical services related to gender reassignment” while continuing to exclude coverage for “gender reassignment surgeries, including secondary surgeries," according to the lawsuit.
The plaintiffs' lawyers say this rule change has not yet been finalized, and even if it is, it does not go far enough because it continues to exclude surgical gender-confirming care from being covered.
Carl Charles, an attorney with Lambda Legal, is one of the lawyers representing the plaintiffs. His team helped win a recent ruling in Alaska in which a federal judge sided with a transgender state employee who sued the state on a similar allegation of health care discrimination.
If no settlement is reached within the next two months, “we’ll get a decision probably sometime next spring,” Charles said.
A representative from the Alaska Department of Law said in an email that the state was currently in ongoing settlement negotiations and had no further comment.
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