Judge: Federal Law Bars Denying Insurance Coverage for Transgender Medicine

Denying insurance coverage for transgender health care is unlawful under the Affordable Care Act and federal laws prohibiting sex discrimination, a federal judge in St. Paul ruled Thursday in a case that is being closely watched nationally.

The opinion came in the case of a Minnesota woman who sued her employer, Essentia Health, for denying coverage for her son’s gender transition, including surgery and medications. HealthPartners, as the plan administrator, was also named as a defendant.

While it does not decide the underlying lawsuit, Judge Donovan Frank’s ruling settled a key legal question that could have implications for future transgender health litigation, attorneys said Friday. That would be true especially if the Trump administration follows through on its stated intention to roll back Obama-era regulations that required health insurers to cover transgender health care.

“By denying health care coverage for treatment that was not only warranted but prescribed by a doctor, ­Essentia and HealthPartners clearly discriminated against my son and violated the law,” said Brittany Tovar, a nurse practitioner from Ada, Minn., who used to work for Essentia, a Duluth-based health care system.

“It is a huge victory where there are not many precedents,” said Omar Gonzalez-Pagan, a senior attorney and health care strategist with Lambda Legal, an LGBTQ legal rights group that has no connection with the case. “This is one of three rulings [nationally], all of them in our favor.” (Read more from “Judge: Federal Law Bars Denying Insurance Coverage for Transgender Medicine” HERE)

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