Opinion ID: 6321961
Heading Depth: 3
Heading Rank: 5

Heading: Hysterectomies unless determined

Text: medically necessary. 8 DOE V. SNYDER (Emphasis added). Plaintiffs asserted that the Challenged Exclusion violates their civil rights under Section 1557 of the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. § 18116; the Early and Periodic Screening, Diagnostic and Treatment requirements of the federal Medicaid Act, 42 U.S.C. §§ 1396a(a)(10)(A), 1396a(a)(43), 1396d(a)(4)(B), 1396d(r); the comparability requirement of the Medicaid Act, 42 U.S.C. § 1396a(a)(10)(B); and the Equal Protection Clause of the Fourteenth Amendment to the Constitution. Plaintiffs sought to represent a class of transgender individuals under the age of 21 who seek male chest reconstruction surgery (sometimes referred to as “top surgery”). 2 Along with their complaint, Plaintiffs filed a motion for preliminary injunction asserting that both Plaintiffs “urgently need male chest reconstruction surgery to alleviate their gender dysphoria” and that there is “broad consensus within the medical community that the surgery is a safe, effective, and medically necessary treatment for many 2 The complaint sought the certification of the class, the appointment of Plaintiffs as representatives of the class, and the appointment of counsel for the class. It also sought preliminary and permanent injunctions on behalf of Plaintiffs, and all similarly situated individuals, and declaratory judgment that the denial of coverage for male chest reconstruction surgery violated the Medicaid Act, the ACA, and the Equal Protection Clause of the Fourteenth Amendment. Plaintiffs defined the proposed class as “[a]ll transgender individuals under age 21 who are or will be enrolled in AHCCCS, have or will have a diagnosis of gender dysphoria, and are seeking or will seek coverage for male chest reconstruction surgery following a determination by their respective health care providers that the procedure is necessary to treat their gender dysphoria.” DOE V. SNYDER 9 individuals with gender dysphoria, including adolescents.” 3 The motion stated that the surgery is not cosmetic, but functional. It explained that “[a]s a result of the surgery, a transgender male’s body matches the person’s internal identity, thereby providing enormous psychological relief, and enables them to interact with others and to function in a male identity much more effectively and confidently.” The motion further asserted that the surgery would eliminate the need for a chest binder, the extended use of which can cause difficulty breathing, exacerbate preexisting pulmonary conditions like asthma, and cause serious skin conditions. The motion recited Plaintiffs’ histories of gender dysphoria and their continued experiences of significant emotional distress and significant physical discomfort and pain. Both Plaintiffs had been taking testosterone for more than a year and had regularly worn their binders for far longer than the maximum daily time recommended by their health care providers. Both Plaintiffs also had various psychiatric issues. Doe had a referral letter for surgery from his mental health provider but was unable to schedule a surgical consult because he cannot afford the surgery and the AHCCCS will not cover it. 3 Plaintiffs asserted that the “process of undergoing these treatments is called ‘gender transition’ and is guided by well-established, internationally recognized standards of care developed by the World Professional Association for Transgender Health (WPATH).” They further stated that the WPATH standards have been adopted by major professional associations of healthcare providers including the American Medical Association, American Psychological Association, the American Academy of Pediatrics, and the Endocrine Society. 10 DOE V. SNYDER