In Lange v. Houston County, the 11th Circuit Court of Appeals ruled that it was a violation of Title VII of the Civil Rights Act of 1964 (Title VII) for an employer to deny coverage for gender-affirming care. Specifically, the court held that the exclusion constituted discrimination on the basis of sex in violation of Title VII because transgender persons are the only plan participants who would seek or qualify for gender-affirming surgery.
The decision comes on the heels of the issuance of final rules under Section 1557 of the Affordable Care Act, which prohibits discrimination in certain health programs and activities. The final rules, which are currently being challenged in court, explicitly clarify that sex discrimination includes discrimination based on gender identity.
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