Gender-Affirming Care Can't Be Denied by Employer, Federal Court Rules

A federal court in Georgia has ruled that employers who refuse to cover gender-affirming health care for workers are in violation of U.S. civil rights law.

Marc Treadwell, chief judge of the U.S. District Court for the Middle District of Georgia, Macon Division, issued the ruling Thursday in the case of Lange v. Houston County. Anna Lange, a sheriff's deputy in Houston County, Ga., sued in 2019 because she had been repeatedly denied insurance coverage for gender-affirming care under the county's employee health plan.

Lange came out to her colleagues and supervisors as a transgender woman in 2017, after having worked for the county since 2006. In seeking the care she was prescribed by her doctor, she found out that the health plan excluded gender-confirmation procedures.

"Lange and her attorneys repeatedly attempted to persuade her employer to reconsider its decision, testifying before the Houston County Board of Commissioners and filing charges with the Equal Employment Opportunity Commission," says a press release from the Transgender Legal Defense and Education Fund, which represented her along with various other attorneys.

Treadwell ruled that denial of this coverage violates Title VII of the Civil Rights Act of 1964. He drew on the 2020 U.S. Supreme Court decision in Bostock v. Clayton County, which held that Title VII, in banning sex discrimination, bans discrimination based on sexual orientation and gender identity. Bostock had not been decided when Lange filed her suit, but it had when the district court heard oral arguments, so it applied in her case, Treadwell wrote.

"The implication of Bostock is clear," he wrote. "In Bostock, the Supreme Court recognized that Title VII delivers a message 'equally simple and momentous: [a]n individual's ... transgender status is not relevant to employment decisions.' ... Discrimination on the basis of transgender status is discrimination on the basis of sex and is a violation of Title VII."

Treadwell also noted that the county excluded gender-affirming treatment from its health plan even though its insurance administrator noted that this would violate Section 1557 of the Affordable Care Act.

"It's a huge relief to know that I can finally receive the medically necessary care that I was repeatedly and unfairly denied," Lange said in the press release. "I can confidently move forward with my life knowing that gender-affirming care is protected under federal law. This decision is not only a personal victory, but a tremendous step forward for all transgender Southerners who are seeking insurance coverage for medically necessary care." Denial of this coverage is common in the South, according to national surveys.

"The court's decision makes clear that depriving transgender people of health care is not only immoral but also illegal," said TLDEF Legal Director David Brown. "An employer cannot refuse health coverage to a transgender employee who needs access to medically necessary, lifesaving care. This ruling will have transformative impact on the quality of life for countless transgender people who live in the South."