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Transgender Bias Claim Against Pennsylvania

(CN) - Pennsylvania discriminates against clinically distressed transgender people by denying Medicaid coverage for sex-reassignment surgery, a transgender man claims in federal court.

John Doe, a "categorically needy" Medicaid recipient, sued Pennsylvania Department of Human Services Secretary Theodore Dallas in Philadelphia Federal Court on Wednesday.

Doe, 30, says he has received Medicaid benefits since 2013, lives in Delaware County, Pa., and supports himself with supplemental security disability income and food stamps.

He is transgender, which he calls "a biological condition, due to brain neuroanatomy and the formation of that brain neuroanatomy in the womb."

"Transgender (or 'trans') people are born with bodies whose anatomy and gender is [sic] different from what they actually are," the complaint states.

Doe also has gender dysphoria, "a medical and therapeutic diagnosis referring to the physical, mental and emotional difficulties that may arise in trans people due to the conflict between their brain anatomy and body anatomy," according to the lawsuit.

The condition allegedly amounts to "'clinically significant distress' associated with being trans."

Doe says "medically necessary" procedures used to treat gender dysphoria "may include hormone or other prescriptions, therapy, gender confirmation surgery ('GCS' or 'bottom surgery'), breast implants or removal ('top surgery'), and others, including hysterectomy, genital reconstruction, and plastic surgery."

Such treatments are "recognized as safe, effective, and warranted" by the American Medical Association, American Psychiatric Association, U.S. Department of Health and Human Services, and Pennsylvania's Physician General Dr. Rachel Levine, among others, Doe claims.

But after Doe's doctor billed Medicaid for a total abdominal hysterectomy on July 9, 2015, Keystone First Health Plan denied the request weeks later, according to the complaint.

An administrative law judge denied Doe's appeal on Oct. 26, finding that certain state regulations ban coverage of medically necessary treatments for Medicaid recipients diagnosed with gender dysphoria, the complaint states.

The ban is "unreasonable, discriminatory, and has no rational basis," Doe claims.

The regulation prevents doctors from alleviating gender dysphoric patients from "constant suffering, emotional, and mental distress," according to his lawsuit.

Dallas and his department "are aware of established medical and scientific evidence that treatment is medically necessary for those diagnosed with [gender dysphoria] GD," including some of their insured employees, the complaint states.

But Medicaid recipients "who have not been diagnosed with [gender dysphoria] GD and have been prescribed a medically necessary hysterectomy will receive Medicaid coverage," Doe alleges.

The four-count complaint alleges violations of the equal protection and supremacy clauses, Affordable Care Act and Medicaid Act.

Doe seeks a permanent injunction, compensatory and punitive damages, costs and attorney's fees.

He is represented by Julie Chovanes with Trans Resource Foundation LLC (Trans-Help) in Philadelphia and Paul Fitzmaurice in Haddonfield, N.J.

Pennsylvania Department of Human Services spokeswoman Kait Gillis declined to comment on the pending litigation.

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