Wisconsin must pay the gender reassignment surgery for two transgender Medicaid recipients, a federal judge in Madison has ruled.
Cody Flack of Green Bay and Sara Ann Makenzie of Baraboo filed a lawsuit in April that claimed that Wisconsin's denial of coverage for transgender surgeries violated the Affordable Care Act and their "equal protection rights," the Milwaukee Journal Sentinel reported.
A rule that excludes coverage of “undefined transsexual surgery" was adopted in 1996, the report said.
On Wednesday, U.S. District Judge William Conley granted a preliminary injunction to bar enforcement of the rule. Conley also suggested the injunction be expanded to include “any transgender Medicaid patient whose doctor recommends the surgery,” according to the report.
“The likelihood of ongoing, irreparable harm facing these two individual plaintiffs outweighs any marginal impacts on the defendants' stated concerns regarding public health or limiting costs," Conley wrote in a 39-page order.
Have they planned surgeries?
Flack, 30, could get his surgery as early as two or three weeks, Attorney Rock Pledl said in the report. Makenzie may have to wait a few months because of HMO paperwork.
According to the report, Flack has “cerebral palsy, uses a motorized wheelchair and “relies on Supplemental Security Income for the disabled as his sole support,” the report said. He reportedly first identified as a boy at age 5.
Makenzie, 41, is also disabled and relies on Supplemental Security Income. She has identified as a woman since 2012.
"This is tremendous," Pledl reportedly said after the ruling.
Wisconsin has a Medicaid budget of about $9.7 billion for about 1.2 million eligible residents, according to the report. Of those, about 5,000 enrollees are transgender.
The Journal Sentinel reported the following details:
“[Makenzie] has been getting estrogen since 2013 — even though, under the regulation, it would be prohibited — and it has helped her. Both she and Flack fear that their hormone coverage might be rescinded at any time, since it also appears to be prohibited by the regulation, but was nevertheless approved.
While Flack seeks removal of his female breasts, Makenzie seeks genital transformation surgery. She took out a $5,000 loan to pay for breast implants after being denied Medicaid coverage.
After breast augmentation , Makenzie she has reported less mistreatment for being perceived as male. But she can't afford to take a loan for genital reconstruction, a much more expensive procedure.”