Transgender-Care Exclusion Case Faces Trial
By ADAM KLASFELD
MANHATTAN (CN) — With New York's longstanding transgender-care exclusions declared illegal, the Empire State must now stand trial over what treatments currently labeled cosmetic or banned for minors qualify for Medicaid, a federal judge ruled.
Former Gov. George Pataki's ban on Medicaid payments for transgender care had been on the books for 16 years before Bronx resident Angie Cruz led a class-action lawsuit opposing the policy in 2014.
The following year, the state's Department of Health lifted the prohibition but stopped short of the full spectrum of coverage. The reformed regulations denied payments for facial feminization surgery, breast augmentation, tracheal shaving and other treatments that the state considered cosmetic.
The state also refused Medicaid coverage for transgender care administered to people under the age of 18, such as pubertal suppressants, commonly known as puberty blockers.
On Wednesday, U.S. District Judge Jed Rakoff found that the blanket ban on "cosmetic" treatment violated the Medicaid Act, which requires the state to provide "medically necessary care."
Cruz's lawyers celebrated the ruling in a conference call on Thursday evening.
Kimberly Forte, a supervising attorney with The Legal Aid Society's LGBT Law and Policy Initiative, said that the clients she contacted have been "thrilled" with the judge's decision.
"It's very unclear as to when the regulation will actually be changed and the new regulation will go into effect," Forte said.
A date has not been set for a trial to determine whether treatments like puberty blockers quality for coverage.
On the road to trial, Cruz's lawyers presented testimony by such expert physicians as Johanna Olson from the Children's Hospital of Los Angeles and Nicholas Gorton from Kings County Hospital in New York.
Mary Eaton, a partner at Willkie Farr & Gallagher LLP, said that the city had "no medical experts, no experts at all."
Judge Rakoff's opinion confirms that this is not an exaggeration, blasting the state for submitting "inadmissible hearsay" and concluding that its sole expert "did not opine on the efficacy of treatments for individuals with gender dysphoria."
Eaton added in a statement that the ruling demonstrates "Albany turned a deaf ear to the chorus of medical experts" on transgender treatment for 16 years.
For Mik Kinkead, an attorney with the Sylvia Rivera Law Project, or SRLP, the development marks a victory "not only for the transgender community but also all low-income New Yorkers" to keep the state from determinations of medically necessary care.
Founded in 2002, SRLP takes its name from the late transgender activist Sylvia Rivera, one of the central figures of the Stonewall Inn uprising that launched the modern LGBT liberation movement.
The organization has been fighting Pataki's regulation from its earliest days, and Kinkead said of its namesake: "I think she would be very excited, especially for young people, because she advocated for young people."
The Department of Health said it is reviewing the judge's decision.
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