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Federal judge overturns Wisconsin Medicaid provision barring transgender surgery
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Federal judge overturns Wisconsin Medicaid provision barring transgender surgery

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A federal judge has overturned a Wisconsin provision that barred transgender Medicaid recipients from receiving coverage for gender reassignment surgery and hormone treatment.

U.S. District Judge William Conley ruled Friday in favor of four transgender Wisconsin residents whose lawsuit challenged a 1997 administrative provision under the state Department of Health Services that excluded coverage of “transsexual surgery” for Medicaid recipients.

The plaintiffs argued gender-confirming treatment was necessary due to “gender dysphoria” — a medically recognized condition in which a difference in the gender someone was assigned at birth and the gender with which the person identifies can cause distress.

“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,” Conley wrote.

Conley’s 38-page ruling follows a temporary injunction against the provision he issued last year.

He wrote that by the state’s Medicaid program, which is jointly funded by state and federal money, not covering the treatments, it was discriminating on the basis of sex under the federal Affordable Care Act.

Insurance companies that manage state HMO Medicaid plans also “acknowledge that gender-confirming hormone and surgical treatments for gender dysphoria can be medically necessary,” Conley wrote.

According to the ruling, DHS estimates gender-confirming treatments covered by Medicaid would cost between $300,000 to $1.2 million annually, while the state spends $3.9 billion annually as part of its share of Wisconsin’s Medicaid program.

Wisconsin is among nine states that have explicit Medicaid exclusions for gender-confirming treatments, according to the ruling.

Almost a year ago, state workers were granted coverage for transgender surgery after a board that oversees benefits narrowly approved restoring the coverage.

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