Transgender Teens File Surgery Ban Class Action Lawsuit

Two teenagers have filed a civil rights class action lawsuit over Arizona Medicaid’s ban on coverage for surgeries and other medically necessary treatments for transgender patients.

The plaintiffs, identified in the complaint only as D.H., 17, and John Doe, 15, have sued Jami Snyder, the director of the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency.

Both teens have been diagnosed with gender dysphoria and live as male “in every aspect of their lives,” even though they were born female.

D.H. says he first became aware of his male gender identity around the age of 4, but was unable to communicate that to his mother, which led him to developing psychological distress at a young age.

His mother, being concerned for D.H.’s safety and well-being, placed him in a psychiatric treatment facility several times.

D.H. finally told his mother at age 13 that he was transgender, and she arranged for him to see a mental-healthcare provider that had experience with transgender youths. 

D.H. began his transition at the recommendation of his healthcare providers and, as part of his treatment, started taking testosterone.

He started wearing a binder to flatten his chest, the complaint says, and while this helped alleviate his gender dysphoria, it also causes pain which interferes with his “ability to focus on school and homework” and prevents him from taking part in prolonged or intense physical activity.

Last year, his pediatrician and therapist recommended male chest reconstruction surgery to D.H. as a means of further alleviating his gender dysphoria, the complaint says. But prior authorization for this surgery was denied.

The transgender surgery class action lawsuit explains gender dysphoria is “the distress that can result from the incongruence between a person’s gender identity and their assigned sex at birth,” and calls it a serious medical condition that can cause anxiety, depression or suicidal thoughts if left untreated. 

Plaintiff John Doe became aware of his male gender identity at the onset of puberty, the class action lawsuit says. Doe kept this knowledge a secret because he was worried about his family’s reaction, and began to develop depression and suicidal thoughts.

About six months later, Doe finally reached out to family members for help, the complaint says. He started using a male name and pronouns, which helped alleviate his gender dysphoria.

Doe began seeing a specialist at Phoenix Children’s Hospital in November 2018, the complaint says.

Doe, like D.H., wears a binder, but feels uncomfortable being out without layers of clothing, even in summer.

Doe’s healthcare providers recommended around February 2020 that he pursue male chest reconstruction surgery, the class action lawsuit says. However, due to Arizona’s exclusions, he also is not able to receive the recommended surgery.

“The Challenged Exclusion unlawfully denies medically necessary surgical care to transgender beneficiaries on AHCCCS. Arizona disregards the transition-related health care needs of Medicaid’s transgender beneficiaries,” the transgender class action lawsuit says. “In doing so, Arizona exposes transgender people to significant and avoidable harms to their health and well-being, in violation of the U.S. Constitution and federal law.”

Arizona is among 10 U.S. states that explicitly ban healthcare coverage for transgender Medicaid recipients, according to LGBTQ think tank Movement Advancement Project, NBC News reported. Twenty-two states and Washington, D.C., explicitly cover such care; 18 states have no explicit policy.

“Categorically excluding surgical treatment for gender dysphoria impermissibly discriminates against transgender people,” Asaf Orr, senior staff attorney and director of the Transgender Youth Project at the National Center for Lesbian Rights, said in a statement.

“There is no legitimate justification for Arizona’s refusal to provide this critical care to transgender Medicaid recipients. Instead, excluding that care creates unnecessary barriers that prevent transgender young people from thriving in every aspect of their lives and can cause lifelong harms.”

The proposed Class would include all transgender individuals younger than 21 “who are or will be enrolled in AHCCCS, have or will have a diagnosis of gender dysphoria, and are seeking or will seek coverage for male chest reconstruction surgery following a determination by their respective health care providers that the procedure is necessary to treat their gender dysphoria.” 

The plaintiffs seek preliminary and permanent injunctions prohibiting AHCCCS from “further enforcement or application of the Challenged Exclusion” and directing AHCCCS to provide coverage for medically necessary male chest reconstruction surgery.

They also seek a declaratory judgment that the denial of coverage for the surgery violates their civil rights under the Patient Protection and Affordable Care Act; several requirements of the federal Medicaid Act; and the Equal Protection Clause of the 14th Amendment.

In addition, the plaintiffs are asking the Court for reasonable attorneys’ fees, costs and expenses and any other award deemed appropriate.

Do you think Arizona has a right to prohibit reconstructive surgery and other treatments for gender dysphoria? Let us know in the comments.

The plaintiffs are represented by Daniel C. Barr and Janet M. Howe of Perkins Coie LLP; Brent P. Ray and Andrew J. Chinsky of King & Spalding LLP; Asaf Orr of the National Center for Lesbian Rights; and Abigail K. Coursolle and Catherine McKee of the National Health Law Program.

The Arizona Transgender Surgery Class Action Lawsuit is D.H., et al. v. Jami Snyder in her official capacity as director of the Arizona Health Care Cost Containment System, Case No. 4:20-cv-00335-SHR, in the U.S. District Court for the District of Arizona.

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