Two Wisconsin Residents With Gender Dysphoria Sue State as ‘Transsexual Surgeries’ Not Covered by Medicaid

Photo Credit: Fernando Audibert

MILWAUKEE, Wisc. — Two Wisconsin residents who suffer from gender dysphoria have filed a lawsuit against the state’s Department of Health Services (DHS) after learning that its Medicaid program does not cover sex change-related operations.

Both of the plaintiffs, who go by the names Cody Flack (a woman who identifies as a man) and Sara Ann Makenzie (a man who identifies as a woman), sought coverage for chest reconstruction surgery. Mackenzie desired coverage for breast augmentation, and Flack sought coverage for a double mastectomy.

The lawsuit, while noting that gender dysphoria is “a serious medical condition recognized by the American Psychiatric Association,” refers to Flack as being a man and Makenzie as being a woman.

“Despite his efforts to present as the man he is, he considers the breasts an undesirable visible marker of something he is not—female—that subjects him to mistreatment, social stigma, and related symptoms of gender dysphoria and emotional distress,” the legal complaint states of Flack. “At various points in his life, … Flack has felt helpless and has had thoughts of suicide and self-harm because of the presence of his breasts.”

“Although her hormone treatments resulted in some breast growth, those treatments alone provided inadequate for the development of female-appearing breasts. As a result, … Makenzie has been perceived by others to be a man and has consequently experienced mistreatment and harassment,” it says of Makenzie.

“In 2017, in consultation with her medical providers, … Makenzie sought to obtain chest reconstruction surgery in the form of breast augmentation to outwardly appear as the woman she is and to treat her gender dysphoria.”

However, they were both told that Medicaid does not cover their desired operations. Upon belief, “transsexual surgeries” were among six services and procedures listed in a bulletin in the 1990’s that were determined to be medically unnecessary.

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Flack and Makenzie are now challenging the exclusion and are arguing that the surgeries are needed for their treatment of gender dysphoria.

“There is no medical or scientific support for Wisconsin’s contention that transition-related health care for transgender people with gender dysphoria is ‘medically unnecessary,’” the suit states. “To the contrary, there is a strong consensus among medical and mental health professionals that gender-confirming surgical procedures and hormonal treatments are the only safe and effective medical treatments for the gender dysphoria experienced by many transgender people.”

“If Defendants continue to deny Wisconsin Medicaid coverage to … Flack and … Makenzie for their surgical treatments for gender dysphoria, the above-referenced harms to their physical and emotional health and well-being will continue, subjecting each of them to significant ongoing risks to their health and safety,” it contends.

Flack and Makenzie are seeking a permanent injunction against the State’s exclusion and a declaration that the practice violates the Affordable Care Act, the Medicaid Act and the Equal Protection Clause of the Fourteenth Amendment.

Read the legal challenge in full here.

As previously reported, Walt Heyer, a man who identified as a woman for eight years until he became regenerated by the Spirit of God, wrote an article in 2017 remarking that allowing those with gender dysphoria to conform their bodies to their psychology does not solve the underlying problem.

“Too many U.S. medical practitioners direct all gender-distressed people toward the extreme measures of conforming the body to the mind, rather than exploring the psychological issues that lie beneath the feelings,” he stated. “Giving powerful hormones and recommending radical surgeries without screening for psychological issues first causes great harm to the patients and their families.”

“Many people who are regretful and suicidal followed to the letter the generally accepted treatment protocol of doctor-prescribed hormone therapy and genital surgery,” Heyer, who now helps those with sex-change regret, outlined. “It is not homophobic, transphobic, or bigoted to look at the causes of dissatisfaction and suicide among the transgender population. Rather, it is a caring, heartfelt way to prevent dissatisfaction and suicides.”


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