Transgender procedures now covered by state employee plans in 36 states, DC but legal battles loom

Thirty-six states and Washington, D.C., either include or do not explicitly exclude healthcare coverage for transgender-related procedures for state employees, with Arizona becoming the most recent through an executive order by the state's Democrat governor. 

Late last month, Arizona Gov. Katie Hobbs removed an exclusion to the state healthcare plan that had prevented coverage of transgender-related procedures. This issue comes as at least 20 states have either restricted or banned such procedures for minors, with most of the states enacting laws this year. 

According to an analysis by the independent, nonprofit group Movement Advancement Project of state healthcare plans, with some slight differences in execution, the states that include healthcare coverage for transgender-related procedures for state employees are Arizona, California, Connecticut, Delaware, Washington, D.C., Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Washington, and Wisconsin. 

Idaho had excluded such procedures from its state healthcare plan before including them in 2020. North Carolina has included the coverage amid a lawsuit against the state for excluding the coverage, but its case is currently scheduled to be heard in September before the entire 4th Circuit Court of Appeals. 

The court will hear the lawsuit against North Carolina along with a lawsuit against West Virginia, which currently has exclusions to the transgender-procedure coverage. Tennessee, which also excludes such coverage, is facing a lawsuit in federal court. 

In 2018, the Wisconsin Group Insurance Board reversed Gov. Scott Walker’s (R) requested exclusion for transgender procedure coverage, allowing coverage for such procedures to be included. 

The states that do not explicitly include or exclude coverage for these procedures are Alabama, Alaska, Colorado, Iowa, Michigan, Missouri, New Mexico, South Carolina, Vermont, Virginia and Wyoming, according to MAP's analysis. 

Alaska had an exclusion that was ruled unlawful in federal court in 2020. Virginia had excluded state healthcare coverage for transgender procedures but then removed the exclusion in 2017. 

The states that exclude transgender procedure coverage are Arkansas, Florida, Georgia, Louisiana, Mississippi, Nebraska, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, and West Virginia. 

At the end of June, Hobbs signed an executive order removing an exclusion that kept state employees from using their healthcare for gender-reassignment surgeries. 

The order states the exclusion that began in 2017 was for “‘gender reassignment surgery’ … even in cases where the surgery is medically necessary.”

Hobbs’ order adds that the exclusion was “not consistent with the coverage offered by the state’s health insurance carriers’ standard benefit packages, which does not include any comparable exclusion.” 

Arizona state Senate President Pro Tempore T.J. Shope, a Republican, responded to the executive order, saying, “Instead of helping families struggling to keep a roof over their heads, fill their tanks with gas and put food on the table, Governor Hobbs is making sure taxpayer dollars are instead going towards elective, sex change surgeries. The Governor continues to show just how tone deaf and out of touch she is with the majority of hard-working Arizonans.” 

The War Room Twitter account for Kari Lake, the Republican candidate who lost to Hobbs in the 2022 Arizona governor's race, also reacted, saying, “Many Arizonans are struggling to feed their families. Now, @katiehobbs is requiring them to pay for the genital mutilation of state employees. It's sickening to see hardworking Arizonans having to foot the bill for Hobbs' assault on basic biology.”