Medically necessary’ transgender surgery now covered by Wisconsin Medicaid

Courtney Sherwin and Marie Kelly, back row, left to right, and Cody Flack and Sara Ann Makenzie, front row, left to right, sued Wisconsin for “medically necessary” gender-changing surgery.(Photo: Nicole Acosta)

Taxpayers will now be on the hook in Wisconsin for other people’s “medically necessary” gender-changing surgery, after a federal judge found that categorically denying Medicaid coverage for it violated patients’ civil rights and federal health care law.

Attorneys for transgender people who sued last year announced a settlement on Dec. 17 in the class action case, according to the Milwaukee Journal Sentinel.

U.S. District Judge William Conley, of Madison, noted the “consensus within the medical profession (is) that gender dysphoria is a serious medical condition, which if left untreated or inadequately treated can cause adverse symptoms, such as anxiety, depression, serious mental distress, self-harm, and suicidal ideation.”

It is not known if medical procedures to outwardly reshape body parts and change body chemistry will relieve these ills.

The four named plaintiffs will divide about $840,000 in damages. The state will pay about $1.35 million to three law firms who handled their case.

As part of the Tuesday’s settlement, the state Department of Health Services must adopt and publicize a new, inclusive policy and notify transgender Medicaid recipients who may have been denied coverage in the past that they may now be eligible.

An estimated 5,000 transgender Wisconsin residents are enrolled in Medicaid. But only some of them suffer from gender dysphoria, and only a portion of those would desire gender-confirming surgeries and meet the medically necessary threshold for coverage. Gender dysphoria refers to the range of conditions suffered by those who identify as a gender other than the one they really are.


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