A federal judge has ruled that the Affordable Care Act (ACA) requires Wisconsin to end a discriminatory practice of refusing to cover medical care for transgender citizens receiving Medicaid, in a strongly-worded ruling that could impact numerous other states.
Wisconsin is among nine states that currently have laws blocking transgender Medicaid recipients from receiving coverage for transition-related care. According to the Movement Advancement Project, states like Alaska, Wyoming, Tennessee, Georgia, and Ohio all specifically ban transgender coverage and care, and an additional 23 states have no specific protections for patients seeking transition-related care.
That could change in the coming years, with litigation ongoing in Wisconsin and Iowa. Earlier this year, the Iowa Supreme Court ruled against the state's exclusion, but Gov. Kim Reynolds, a Republican, responded by signing a law forcing even tighter restrictions. An ACLU lawsuit in Iowa is currently pending.
This week's ruling in Wisconsin establishes a strong federal precedent that could lead to victories in other states. The district court had already issued and injunction earlier this year requiring the state to provide coverage, and now in his ruling, Judge William Conley of the U.S. District Court for the Western District of Wisconsin has affirmed that there is no plausible legal basis for denying care.
Writing in favor of the plaintiffs, Conley acknowledged that medical experts agree that transition-related care is medically necessary. Gender dysphoria "can cause adverse symptoms, such as anxiety, depression, serious mental distress, self-harm and suicidal ideation" if it is "left untreated or inadequately treated," the judge wrote.
Conley further claims that denying such care violates Section 1557 of the Affordable Care Act, which forbids federally funded health centers from discriminating on the basis of gender identity. The Trump administration is currently attempting to eliminate those protections.
Even as the Trump administration attempts to roll back those protections, Conley said that professional organizations including the American Medical Association, Endocrine Society, and American Psychiatric Association "have already endorsed gender-confirming surgeries as medically accepted, safe, and effective treatments for gender dysphoria." In fact, the state's own medical providers have already acknowledged that the existing policy of denying coverage "conflicts with current medical practice."
The state of Wisconsin, however, claimed that covering the transition-related care would be too expensive. Conley found claim that to not be credible, pointing out that the state's own estimate that trans healthcare would cost the state between $300,000 and $1.2 million per year or "one hundredth to three hundredth of one percent of the state's share of Wisconsin Medicaid's annual budget."
While the ruling is decisive, it may not be the end of the case. The parties meet on August 27 with another judge to determine next steps. Wisconsin could appeal the case, and depending on the outcome, it could end up being decided by the U.S. Supreme Court.