Recently, Arizona joined the list of states that include healthcare coverage for transgender-related procedures for state employees, following an executive order issued by Governor Katie Hobbs. This move comes at a time when many states have implemented restrictions or bans on such procedures for minors, with the majority of these laws enacted this year.
An analysis conducted by the independent organization Movement Advancement Project (MAP) reveals that 36 states and Washington, D.C. either provide coverage or do not explicitly exclude transgender-related procedures in their state healthcare plans for employees. These states include 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 previously excluded such procedures from its state healthcare plan but began including them in 2020. North Carolina faced a lawsuit for exclusion but has since included coverage while the case is scheduled to be heard in September by the 4th Circuit Court of Appeals. The court will also hear a similar lawsuit against West Virginia, which currently has exclusions. Tennessee, another state with exclusionary policies, is facing a federal lawsuit.
In 2018, the Wisconsin Group Insurance Board overturned the exclusion requested by former Governor Scott Walker (R), allowing coverage for transgender procedures.
The analysis by MAP reveals that there are states that neither explicitly include nor exclude coverage for transgender procedures. These states are Alabama, Alaska, Colorado, Iowa, Michigan, Missouri, New Mexico, South Carolina, Vermont, Virginia, and Wyoming. Alaska had an exclusion that was ruled unlawful in federal court in 2020, and Virginia previously excluded coverage but removed the exclusion in 2017.
States that explicitly exclude transgender procedure coverage include Arkansas, Florida, Georgia, Louisiana, Mississippi, Nebraska, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, and West Virginia.
In late June, Governor Hobbs signed an executive order to remove the exclusion that prevented state employees from utilizing their healthcare for gender-reassignment surgeries. The order highlights that the exclusion, implemented in 2017, was not consistent with the standard benefits packages provided by the state’s health insurance carriers.
Responding to the executive order, Arizona state Senate President Pro Tempore T.J. Shope, a Republican, expressed opposition, stating that taxpayer dollars were now being allocated towards elective gender-reassignment surgeries instead of assisting struggling families. Kari Lake, the Republican candidate who ran against Hobbs in the 2022 Arizona governor’s race, also criticized the decision, characterizing it as an assault on basic biology and an undue burden on hardworking Arizonans.