Four transgender government employees across three departments hit Georgia agencies and several top government officials with an employment discrimination suit in federal court Wednesday, challenging the State Health Benefit Plan's continued denial of gender-affirming care.

The State Health Benefit Plan discriminates against transgender people by excluding coverage for hormone replacement therapy and surgical care, even though the plan covers similar treatments by cisgender people, according to the suit filed against the state of Georgia, the Georgia Department of Community Health and the Georgia Board of Community Health, among other agencies.

"The exclusion communicates to transgender persons and to the public that their state government deems them unworthy [of] equal treatment," the complaint said. "It also reinforces the stigma attached to being transgender, suffering from gender dysphoria and seeking a gender transition."

The suit, filed by Micha Rich, a Department of Audits and Accounts worker; Benjamin Johnson of the Bibb County School District; and two anonymous workers, one from the Division of Family and Children Services and the other from the Campaign for Southern Equality, claims that the exclusions violate Title VII of the Civil Rights Act and the 14th Amendment's equal protection clause.

The 62-page complaint claims that UnitedHealthcare, which operates Georgia's health plan along with Anthem, excludes coverage for care that would otherwise be considered medically necessary when needed for the purpose of "sex transformation operations and related services."

"It lists this exclusion under the heading 'personal care, comfort or convenience,' along with televisions, air conditioners and barber service," the complaint said. "Likewise, Anthem withdraws coverage for care that would otherwise be covered as medically necessary when it is needed for 'a sex change and/or the reversal of a sex change.'"

In a Wednesday interview, Rich told Law360 that he was denied preauthorization for top surgery in 2019 by the state's health plan, which cited the plan's exclusion of "sex transformation operations and related services."

Rich instead had to save up more than $11,200 to pay for the surgery himself.

"It took a few years but eventually I was able to save the money and have the procedure," Rich said. "All of this is coming from a place of love for Georgia and a desire to make it a better state for all of us."

David Brown of the Transgender Legal Defense & Education Fund, who is representing Rich, told Law360 that this suit was unique because Georgia had already settled two cases surrounding trans exclusions in the state health system.

"Georgia has already been through this twice before with the state health plan, but for some reason they did not end the discrimination in the employee health plan," Brown said.

In June, a Georgia federal judge found that a health plan's exclusion of gender-conforming surgery violated Title VII because it applied only to transgender employees, allowing a transgender sheriff's deputy to move forward with most of her bias claims.

"There's no specific kind of medical care issue here. Rather, it's about care that all other employees can get, but transgender employees cannot," Brown said. "This case is about equality and about removing an exclusion that is in violation of the principles of equality that Title VII and the equal protection clause stand for."

Counsel information for the defendants wasn't immediately available Wednesday and representatives for the state of Georgia did not immediately respond to a request for comment.

The named defendants in the Georgia suit include Louis Amis, executive director of the State Health Benefit Plan, and Norman Boyd, Robert S. Cowles III, David Crews, Russell Crutchfield, Roger Folsom, Nelva Lee, Mark Shane Mobley, Cynthia Rucker and Anthony Williamson, members of the Georgia Board of Community Health.

Also named are Human Services Commissioner Candice L. Broce, State Auditor Greg Griffin and Dan A. Sims, Bibb County superintendent of schools. 

Rich, Johnson and Jane and John Doe are represented by David Brown and Nikki Easterday of the Transgender Legal Defense & Education Fund Inc. and Amanda Kay Seals and Megan Cambre of Bondurant Mixson & Elmore LLP.

The case is Rich et al. v. Georgia et al., case number 1:22-mi-99999-UNA, in the U.S. District Court for the Northern District of Georgia.

--Editing by Karin Roberts.