Making sure that all people have access to affordable, comprehensive health care is a baseline mission that could literally change (and save) lives. That said, as we all know, health care policies don’t always cover procedures that people legitimately do need, instead categorizing them as cosmetic or voluntary. One all too frequent example of this happening? When transgender and nonbinary folks want to get gender-affirming health care covered. We know that safe, age-appropriate, gender-affirming care can be lifesaving, and yet, people report still struggling to access this care and have it covered by insurance.

As reported by the Anchorage Daily News, as of July 25, Medicaid recipients in Alaska will be eligible for partial coverage of important gender-affirming treatments, including surgery and hormonal treatments. Let’s talk about the class-action lawsuit against the Alaska Department of Health and Social Services (DHHS) that preceded the necessary change.

Working with Lambda Legal, an LGBTQ+ advocacy organization, Swan Being, a transgender woman in her 70s, sued Alaska over its exclusionary policy in March 2019. Robin Black and Austin Reed later joined her suit as two additional plaintiffs, reporting they received a lack of coverage for hormonal treatments and surgery.

Being sued after learning that her travel expenses related to seeking health care were not covered, even though, as a rule of thumb, travel expenses are covered under Alaska Medicaid. Being had to travel from her home in Homer to Anchorage for treatment, and even though her doctor thought the travel expense would be covered, it wasn’t. Why was that? She was told “hormonal injections and lab work” for gender affirmation were not covered. Thus, neither was even the associated travel. Even though her doctor believed it medically necessary, even though she had health insurance. 

Depending on your own circumstances, travel costs might not be a big deal. But remember that low-income folks deserve accessible, affordable health care, too. And as Northern Justice Project attorney Goriune Dudukgian pointed out, as reported by Alaska Public Radio, not everyone lives in an area with close options.

“For folks who are living in the off-the-road-system communities, or where they can’t get care within their own communities, the travel component is a really big deal,” Dudukgian stated. 

In the end, the case, Being et al. v. Crum et al, was settled out of court, and the three plaintiffs will receive $60,000 each in damages. The Medicaid policy to categorically exclude “treatment, therapy, surgery, or other procedures related to gender reassignment” is struck as part of the agreement. 

If you’re curious about how much this change in policy is likely to cost the state, it’s estimated that it’ll be about $28,000 per year, according to Lambda Legal attorney Carl Charles. Charles described the change as “lifesaving,” adding that in the big picture, “It will cost the state very little to make these people’s lives really measurably improved.” Charles noted the relatively low cost to the state is partially due to how few openly trans people live in Alaska, and beyond that, how few openly trans folks live in Alaska and receive Medicaid.