Bruce v. South Dakota (USA)

On October 13, Terri Bruce, a transgender man, filed a federal lawsuit in the U.S. District Court for the District of South Dakota, Western Division, alleging the South Dakota State Employee Health Plan “singles out transgender employees for unequal treatment by categorically depriving them of all medical care for gender dysphoria, regardless of whether those treatments are medically necessary under accepted standards of care” in violation of Title VII of the Civil Rights Act of 1964 and the Equal Protection Clause of the Fourteenth Amendment.

Bruce, who is represented by the ACLU, claims the state health plan declined to cover a mastectomy due to the categorical exclusion of “services or drugs related to gender transformations,” however, a mastectomy would be covered for an individual who “had been assigned male at birth and [was] experiencing clinically significant psychological distress from the size of his breasts … as medically necessary”

In its answer, the state admits mastectomy as medically necessary is covered under the health plan, subject to the specific exclusion of coverage for “services or drugs related to gender transformations,” but that “whether there is a legitimate medical justification for the exclusion is the subject of an existing dispute in the medical field.”

State of South Dakota sued over transgender health policy

State denies plan discriminates against transgender members