Jasmine Glenn and Jamie O’Brien are transgender women who have insurance coverage through Michigan’s Medicaid program, which contracts with private insurance companies, Priority Health and Meridian Health, to provide Medicaid services.  Although Ms. Glenn and Ms. O’Brien’s medical providers determined that gender confirmation surgery was medically necessary, Priority and Meridian denied coverage, pointing to their policies that had blanket exclusions for gender confirmation surgery.  The ACLU of Michigan represented both claimants in administrative proceedings, arguing that the blanket exclusions were unlawful. 

In 2018 the Michigan Department of Health and Human Services (MDHHS) instructed Michigan Medicaid insurance programs to remove blanket exclusions from their policies, citing the nondiscrimination requirements of the Affordable Care Act.  Meridian settled with Ms. O’Brien by reimbursing her for the expenses associated with her surgery. 

In November 2018 we filed a complaint with the Michigan Department of Civil Rights against Priority Health regarding its discriminatory policy.  The complaint was settled in December 2020, resulting in Ms. Glenn having her surgery covered as well.  Since then we have continued to represent transgender women in their administrative appeals challenging the denial of coverage for facial feminization surgeries by their Medicaid insurers.  The Michigan Department of Insurance and Financial Services (DIFS), Michigan’s insurance regulatory agency, has repeatedly resolved these appeals in favor of the patients, holding that the insurance companies’ eligibility criteria for coverage of facial feminization surgeries were inappropriate, that the insurance companies must apply the standard of care established by the World Professional Association for Transgender Health (WPATH), and under those standards facial feminization surgery was medically necessary for treatment of gender dysphoria. 

In August 2021 MDHHS issued an official policy directive requiring Medicaid providers to use WPATH standards to determine coverage for gender-confirming treatments and procedures.  (ACLU Attorney Jay Kaplan.)

Status

Filed