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Lawsuit against New York seeks Medicaid coverage for transgender health treatments

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NEW YORK, N.Y. - A lawsuit filed Thursday against New York state seeks Medicaid coverage for transgender people seeking what they consider to be life-saving health treatments, including gender change procedures.

The lawsuit, filed in federal court in Manhattan against the state health commissioner, seeks class-action status on behalf of people seeking hormone therapy and sex reassignment surgery.

A similar federal lawsuit was thrown out in 2008 by a Manhattan judge who said the state had sufficiently explained its rejection of such reimbursement in 1998.

The judge noted that the state cited serious complications from the surgeries and danger from life-long administration of estrogen and testosterone.

The new lawsuit challenges the state on fresh legal grounds, including under the Affordable Care Act, and says scientific evidence now conclusively proves the treatments are safe and effective.

"In the last 15 years there have been significant medical advances," said Elana Redfield, a staff attorney with the Sylvia Rivera Law Project, which provides legal services for people who face discrimination regarding their gender identity and expression. The organization and the Legal Aid Society brought the lawsuit.

The lawsuit notes that several weeks ago, the federal Department of Health and Human Services concluded it was unreasonable to reject Medicare coverage for all gender reassignment surgery based on a 1981 report encompassing studies published between 1966 and 1980.

It said there is evidence that the medical community has since reached a consensus that gender reassignment surgery is an effective treatment for psychological dysfunction brought about a mismatch between a person's birth gender and a person's perception of it.

Redfield estimated more than 8,000 people could be affected by the New York litigation, many of them low income and likely to use Medicaid.

The lawsuit seeks a court order to force the state to fund the procedures.

A message seeking comment from New York's attorney general was not immediately returned.

Kimberly Forte, a Legal Aid attorney, said it was time to raise the issue again because of "societal momentum."

"There's been a climate change and this is the right time for courts to be looking at this issue and for society to be discussing this and fixing these discriminatory practices," she said.

The lawsuit was filed on behalf of two individuals: Angie Cruz, 50, of the Bronx and a 46-year-old Manhattan resident identified in the lawsuit only as I.H. Both seek breast and sex reassignment surgeries.

According to the lawsuit, I.H.'s self-confidence, mental stability and physical comfort suffer because of the mismatch of her birth gender with her gender identity. It said a doctor has blamed mental diagnoses of severe bipolar disorder, post-traumatic stress disorder, anxiety with panic and insomnia on her gender-based disability and said depression leaves her bedridden for extended periods.

The lawsuit said Cruz has identified herself as female since age 10 and she "struggles as a result of having a physical body that does not match her gender identity."

Cruz said she at times has resorted to the black market to obtain hormone treatments.

"I never thought I was a boy, never," she said in an interview.

She said the lawsuit gives her hope.

"I prayed for something like this," Cruz said.

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