Michigan’s Medicaid program contracts with private insurance companies to provide government-funded Medicaid services, and some companies have long resisted transgender patients’ efforts to obtain coverage for gender dysphoria-related treatments even when their medical providers have determined the treatments to be medically necessary. Beginning in 2018 the ACLU of Michigan represented transgender women in multiple administrative appeals challenging denials of coverage for gender confirmation surgery. Following our advocacy efforts, in September 2018 the Michigan Department of Health and Human Services (MDHHS) instructed Michigan Medicaid insurance programs to remove blanket exclusions of gender confirmation surgery from their policies, citing the nondiscrimination requirements of the Affordable Care Act, and our clients’ administrative claims settled. Since then we have continued to represent transgender women in administrative appeals challenging the denial of coverage for facial feminization surgeries. The Michigan Department of Insurance and Financial Services (DIFS), Michigan’s insurance regulatory agency, has resolved the vast majority of these appeals in favor of the patients, holding that 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 April 2021 we appealed a contrary DIFS decision involving Molina Healthcare to the Ingham County Circuit Court, and the case quickly settled. In November 2021, following continuing advocacy efforts, MDHHS issued an official policy directive requiring Medicaid providers to use WPATH standards to determine coverage for gender-confirming treatments and procedures. Despite this directive in September 2022 we were forced to appeal an adverse DIFS ruling involving Blue Cross Blue Shield, and the case settled in July 2023. (Hudson v. Molina Healthcare of Michigan; Wismer v. Blue Cross Blue Shield of Michigan; ACLU Attorneys Jay Kaplan and Dan Korobkin; Cooperating Attorney Gerald Aben of Dykema.)