The state of Georgia will start paying for gender affirmation care for state employees, public school teachers and former employees covered by a state health insurance plan, settling the latest lawsuit aimed at forcing state agencies to pay for surgery and other procedures.

The plaintiffs moved to dismiss their case last Thursday in Atlanta federal court, announcing they had reached a settlement with the State Health Benefit Plan. The December lawsuit argued the insurance plan illegally discriminated against them by refusing to pay for gender affirmation care.

“There’s no justification — morally, medically, legally or in any other way — for treating transgender health care as different and denying people access to it,” says David Brown, a lawyer for the plaintiffs.

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The state Department of Community Health, which oversees the insurance plan, didn’t immediately respond to a request for comment.

As of July 1, 2023, Georgia legally barred new patients younger than age 18 from starting hormone therapy and banned most gender affirmation surgeries for transgender people younger than 18. That law, challenged in court but still in effect, lets doctors prescribe puberty-blocking medications and allows minors already receiving hormone therapy to continue.

But Brown said the settlement requires the health plan to pay for care deemed medically necessary for spouses and dependants as well as employees. That means the health plan could be required to pay for care for minors outside the state even though it’s prohibited in Georgia.

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The lawsuit cited a 2020 Supreme Court ruling that found treating someone differently because they’re transgender or gay violates a section of the Civil Rights Act of 1964 prohibiting discrimination on the basis of sex. The plaintiffs in that case included an employee of Georgia’s Clayton County.

The case is the fourth in a line of lawsuits against Georgia agencies to force them to pay for gender affirmation care. Last year, a jury ordered Houston County to pay US$60,000 in damages to a sheriff’s deputy after a federal judge ruled her bosses illegally denied the deputy health coverage for gender affirmation surgery. Houston County is appealing that judgment and oral arguments are scheduled in November before the 11th U.S. Circuit Court of Appeals.

In 2022, the Department of Community Health agreed to change the rules of the state’s Medicaid program to settle a lawsuit by two Medicaid beneficiaries. In 2019, the University System of Georgia paid $100,000 in damages when it settled a case brought by a University of Georgia catering manager.

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