Idaho governor says Medicaid shouldn’t pay for transgender medical care — for anyone

The state has a forthcoming ban on gender-affirming care for trans youth, but Gov. Brad Little’s position on Medicaid coverage includes both youth and adults

By: - May 3, 2023 3:28 pm
Idaho Gov. Brad Little gives his State of the State speech

Idaho Gov. Brad Little gives his State of the State speech in the House chambers of the State Capitol building on Jan. 9, 2023. (Otto Kitsinger for Idaho Capital Sun)

As a lawsuit by transgender Idahoans against the state’s Medicaid administrators makes its way through federal court, Gov. Brad Little stepped in this week to clarify the state’s official position on the matter.

“It has come to my attention that you and the Department of Health and Welfare are currently being sued for having not pre-authorized Medicaid coverage for the sex reassignment surgeries of two young adults,” Little said in a May 1 letter to Idaho Department of Health and Welfare Director Dave Jeppesen.

“To be clear, I oppose Idaho Medicaid using public funds to pay for irreversible sex reassignment surgeries, puberty blockers, or hormones for the purpose of changing the appearance of any child’s or adult’s sex,” he wrote.

Little said he directed Jeppesen and the Department of Health and Welfare “to take all appropriate steps to implement a policy consistent with state and federal law excluding the same from Medicaid coverage.”

In the letter, Little said he stands firm in his belief that “hardworking taxpayers should not be forced to pay for an adult’s sex reassignment surgery, especially when evidence exists that such procedures are neither medically necessary nor in the best interest of the patient’s mental health.”

The letter does not cite the evidence for those claims.

The current international health care standards say that, based on decades of research into treatments for patients with gender dysphoria, an appropriate treatment plan will depend on the health care provider’s evaluation and varies for each patient. It can, but doesn’t necessarily, include surgery.

Idaho made gender care for minors a crime this year

Starting next year, it will be illegal for Idaho health care providers to give gender-affirming medical treatments to patients under age 18. The ban was passed by the Idaho Legislature earlier this year and signed into law by the governor. It takes effect Jan. 1.

There is no such law against providing gender-affirming care to adults in Idaho.

In fact, the state was ordered in 2020 to pay for surgical care for transgender inmate Adree Edmo, in a lawsuit that made its way to the U.S. Supreme Court and cost the state millions of dollars, according to reports by Boise State Public Radio. Edmo’s medical care at the time was paid for through a state prison contract, as opposed to Idaho Medicaid.

Little’s recent missive was referenced during a hearing Tuesday before Chief U.S. Magistrate Judge Raymond E. Patricco, in a lawsuit filed last fall by two transgender Idahoans, against the state agencies and officials who oversee Idaho Medicaid.

Lawsuit claims Idaho health department discriminates against trans people seeking health care

The plaintiffs, referred to in the case only by their initials, accuse Idaho of discriminating against them by declining to approve coverage for gender-confirmation surgery under the state-run Medicaid program. Both plaintiffs are adults.

The patients’ attorney, Howard Belodoff of Idaho Legal Aid Services, told the judge that Medicaid deemed gender-confirming surgery to be “cosmetic,” while health care providers considered it medically necessary.

Since the only people who are diagnosed with gender dysphoria and need gender-confirming surgery to treat that diagnosis are transgender individuals, Belodoff argued, it is discriminatory to deny coverage for the medical care.

The state disputes that rationale.

Lincoln Davis Wilson, chief of the civil and constitutional defense division of the Idaho Attorney General’s Office, represented the Idaho Department of Health and Welfare in the hearing Tuesday.

Wilson argued that Medicaid does not have to pay for all procedures for all diagnoses. It has paid for some treatments for gender dysphoria for the plaintiffs, he said.

Wilson also argued that transgender health care is “an issue that’s in flux, medically, just like it’s in flux legally.”

The lawsuit is ongoing. Patricco said he will issue a decision soon on whether to dismiss the case, as the state has requested, or allow it to proceed.


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Audrey Dutton
Audrey Dutton

Audrey Dutton was a senior investigative reporter with the Idaho Capital Sun after 10 years at the Idaho Statesman. Her favorite topics to cover included health care, business, consumer protection issues and white collar crime. Before coming home to Idaho, Dutton worked as a journalist in Minnesota, New York, Maryland and Washington, D.C. Dutton's work has earned dozens of state, regional and national awards for investigative reporting, health care and business reporting, data visualization and more.