Georgia Medicaid will cover gender-affirming surgery under settlement

ATLANTA — Georgia’s Medicaid program will now cover gender-affirming surgery as a result of a new settlement in a lawsuit filed by the American Civil Liberties Union.

Gender-affirming surgery includes procedures that help transgender people transition to their self-identified gender.

Georgia Medicaid had barred insurance coverage for gender-affirming surgery since 1993. The new settlement means that the Medicaid program will now cover the surgeries going forward.

The lawsuit started last year when two women enrolled in Medicaid sued the state Department of Community Health because they were denied coverage for their gender-affirming surgeries — which had been recommended by their physicians and mental-health providers.

Aided by the ACLU, the women claimed their health had been harmed by their inability to have the procedures covered by Medicaid.

Now middle-aged, both women were born male but started identifying as female at a young age, according to the complaint they filed with the U.S. District Court for the Northern District of Georgia.

The complaint states that both women suffered mental health consequences because of their inability to get gender-affirming surgery.

They claimed that the bar on the procedures amounted to discrimination on the basis of their sex and transgender status.

The complaint pointed out that other insurers, including the federal Medicare program, typically cover gender-affirming surgery.

The resulting settlement, announced Monday, will now require Georgia Medicaid to cover gender-affirming procedures and adopt new clinical guidelines for when the gender-affirming surgery will be approved.

“Gender-affirming surgeries are safe, effective and medically necessary,” Taylor Brown, a staff attorney with the ACLU LGBTQ & HIV Project, said. “This settlement brings the state of Georgia’s Medicaid program in line with the accepted standards of care and the law. The removal of the exclusion of benefits … will save lives.”

DCH officials declined to comment on the settlement.

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