Florida’s denial of coverage for certain transgender healthcare procedures for employees is discriminatory and violates Title VII of the Civil Rights Act of 1964, a district court judge ruled Aug. 1.
By denying trans public sector employees their medically necessary, gender-affirming care, the state unlawfully discriminated against the plaintiffs on the basis of sex, Judge Mark Walker found (Claire, et. al., v. Florida Department of Management Services).
The Florida Department of Management Services, the defendant in the case, is “responsible for implementing and administering the state group insurance program, which provides health insurance benefits to eligible state employees.”
Each of the plaintiffs — one was a Navy veteran and longtime University of Florida employee; one is a public defender in the office of the 2nd Judicial Circuit; and one worked as a state corrections officer — are or were state employees who received their health insurance as an employer-provided benefit.
The judge had been considering competing motions for summary judgment from both the plaintiffs and employer. He granted partial summary judgment for the workers and denied the employer’s motion.
A precedent for protections
As Judge Mark Walker said in the court document, “Title VII makes it unlawful for an employer to ‘discriminate against any individual with respect to his compensation, terms, conditions, or privileges of employment, because of such individual’s … sex.’”
The Supreme Court’s 2020 Bostock v. Clayton County decision represented an important step forward for transgender workers when it came to Title VII, establishing that discrimination based on gender identity is illegal under the statute.
Citing that case, the court noted that Title VII prohibits “all kinds” of discrimination based on sex, regardless of how “they manifest themselves or whatever other labels might attach to them.” Likewise, “discrimination based on homosexuality or transgender status necessarily entails discrimination based on sex,” because “the first cannot happen without the second,” the judge wrote.
Trans inclusion, beyond compliance
Workplace culture experts have lauded the importance of trans-inclusive healthcare. In recent years, The Human Rights Campaign highlighted the presence of trans-inclusive benefits as a hallmark of holistic LGBTQ+ inclusion.
For its annual Corporate Equality Index, the HRC analyzes the practices of Fortune 500 companies. Overall, 73% of such companies have trans-inclusive benefits.
There is no nondiscriminatory reason for the state to categorically deny coverage of safe, effective, medically necessary treatment only when it is needed to treat gender dysphoria but not for the treatment of any other condition.
Simone Chriss
Director of the Transgender Rights Initiative at Southern Legal Counsel
Of the Fortune 500 companies that volunteered to participate in HRC’s equality analysis, 94% had trans-inclusive healthcare. (Of the Fortune 500 companies that declined to participate, zero had trans-inclusive care benefits.) The former is up from 0% overall, when HRC first started its equality index research in 2002.
Speaking about family planning, transition guidelines and other expansive benefits, HRC President Kelley Robinson said, “These aren’t just policy changes; they’re life-changing actions that make a real difference.”
Treating gender dysphoria: A double standard for medical care
Judge Walker noted the definition of “gender-affirming care” outlined by World Professional Association for Transgender Health: It is “medically necessary for the treatment of gender dysphoria” and can include hormone therapy, psychological care, and “a variety of therapeutic options” to support gender expression.
All of the plaintiffs had gender dysphoria diagnoses; DMS denied one plaintiff’s top surgery, another plaintiff’s bottom surgery and another plaintiff's facial feminization surgery.
“Defendant DMS admits that the challenged exclusion ‘prohibits coverage’ of hormone replacement therapy, double mastectomy, orchiectomy, and any other form of surgical treatment to treat gender dysphoria,” the court noted. “But coverage is provided for mastectomies, orchiectomies, and certain cosmetic procedures if necessary to treat other qualifying conditions.”
Judge Walker cited an 11th Circuit case decided earlier this year, Lange v. Houston County, Georgia, in which the court found that “drawing a line between gender-affirming surgery and other operations, … intentionally carves out an exclusion based on one’s transgender status.”
The ACLU of Florida voiced support for Walker’s decision in an Aug. 2 press release. “There is no nondiscriminatory reason for the state to categorically deny coverage of safe, effective, medically necessary treatment only when it is needed to treat gender dysphoria but not for the treatment of any other condition,” the plaintiffs’ counsel Simone Chriss, director of the Transgender Rights Initiative at Southern Legal Counsel, said in a statement.
Walker ordered an Aug. 16 telephonic conference, “at which time the parties must be prepared to discuss how they intend to proceed with respect to proving damages or any affirmative defenses that would limit Plaintiffs’ damages at trial,” according to court documents.
“We are so grateful that the court is holding the state accountable for its facially discriminatory policy that carves out transgender state employees for unequal treatment,” Chriss said.
