Starting this month, Alaska Medicaid can no longer deny coverage to transgender Alaskans undergoing gender-affirming treatment.
That’s following the January settlement of a class action lawsuit filed by Swan Being, a transgender woman from Homer who said Alaska Medicaid refused to cover costs related to hormone treatment in 2019.
Being sued the Alaska Department of Health and Social Services, which oversees Alaska’s Medicaid program, and department commissioner Adam Crum. She alleged the state’s policies discriminated against transgender Alaskans and violated the 14th Amendment, which grants all Americans equal treatment under the law.
Being was the first to file the case. Robin Black and Austin Reed, both of Anchorage, joined as plaintiffs in 2020.
Up until now, Alaska was one of 10 states that still explicitly denied Medicaid coverage for gender-affirming treatment, including surgery, hormone treatment and therapy. Similar lawsuits are currently in motion in West Virginia and Georgia, said Carl Charles, an attorney with Lambda Legal. He co-counseled the case alongside the Anchorage-based Northern Justice Project.
Charles said that kind of gender-affirming health care is life-saving for transgender people. And he said it’s particularly important to protect access to that health care when it’s contingent upon employment.
“When you consider the transgender people as a group, when you take into consideration that we are chronically underemployed as a result of anti-trans discrimination, that makes health care that much more difficult,” Charles said.
Being relied on Medicaid for her health care and was diagnosed by her doctor with gender dysphoria — a conflict between a person’s assigned gender and the gender with which they identify.
The American Medical Association identifies gender dysphoria as a “serious medical condition,” the lawsuit said, with dire health implications if left untreated. The association said gender-affirming care is linked to a lower rate of suicide attempts among transgender people and overall higher quality of mental health.
Being received hormone replacement therapy and, in 2019, planned to travel from Homer to Anchorage for further treatment.
Alaska Medicaid typically covers travel for medical expenses. But because it didn’t cover the hormone injections and lab work Being sought, it denied her doctor’s request to cover the trip.
The other plaintiffs both reported a lack of coverage for gender-affirming surgery and hormones, according to the lawsuit.
A spokesperson from the Department of Health and Social Services said the changes go into effect July 25. The spokesperson also said the settlement is a result of both the Affordable Care Act and a 2020 Supreme Court Case, Bostock v. Clayton County, that upheld gay and transgender workers are protected under existing civil rights legislation.
The state estimated the regulation change will cost the department an additional $28,000 each year, Charles said.
“Which, if I may say, is a real drop in the bucket,” he said.
He said that’s partly because there are not as many transgender people living in Alaska as in other states. Even fewer are Alaska Medicaid recipients.
“But it is going to be lifesaving,” Charles said. “It will cost the state very little to make these people’s lives really measurably improved.”
A 2015 survey of transgender Americans, including 84 Alaskans, found a third of transgender Alaskans had had issues in that past year with insurance coverage related to being transgender.
Nationwide, the American Medical Association found in 2019 about a quarter of transgender patients seeking coverage for hormones were denied in the year prior. That was true for over half of those who sought coverage for gender-affirming surgery.
Health care costs are compounded for people living in remote communities in Alaska. Goriune Dudukgian, an attorney with the Northern Justice Project, said that was just one manifestation of the discrimination challenged in the suit.
“For folks who are living in the off-the-road-system communities, or where they can’t get care within their own communities, the travel component is a really big deal,” he said.
When it comes to private insurance, however, there is no law barring insurers in Alaska and about half of all other states from excluding transgender-related health care coverage.
All the plaintiffs in the case will also receive $60,000 for damages, according to the settlement agreement.