The state health plan’s refusal to cover the cost of gender dysphoria treatment for transgender individuals amounts to discrimination, according to a federal lawsuit filed Monday.

While hormone therapy and reassignment surgeries were covered in the 2017 plan, they’ve been excluded ever since. 

The lawsuit was filed on behalf five state university employees and their families by Lambda Legal and Transgender Legal Defense & Education Fund. Plaintiffs include Max Kadel, a thirty-six-year-old UNC School of Government employee forced to ration his testosterone medication, and Conor Thonen-Fleck, a sixteen-year-old denied coverage for chest-reassignment surgery.

The defendants include Treasurer Dale Folwell, UNC-Chapel Hill, UNC-Greensboro, and N.C. State, as well as the administrator of the health plan. 

“Revoking health insurance coverage for transgender employees puts the state of North Carolina on the wrong side of history,” said Noah E. Lewis, an attorney with Transcend Legal. “North Carolina otherwise provides excellent health care benefits, so it’s a real betrayal to have the state unfairly turn its back on its own employees and their families who face pressing health care needs.”

In a statement, Folwell, a Republican, made clear the state has no intention of changing the policy anytime soon. 

“Until the court system, a legislative body, or voters tell us that we ‘have to,’ ‘when to,’ and ‘how to’ spend taxpayers’ money on gender reassignment surgery, I will not make a decision that has the potential to discriminate against those who desire other currently uncovered, elective procedures,” Folwell wrote.

While Folwell and other state officials have cited the price tag as a reason or denying coverage, advocates estimate that covering transgender-related treatments would cost between $350,000 and $850,000 annually. Less than 1 percent of adults identify as transgender in the United States, according to research from the Williams Institute. The state health plan covers 720,000 state employees and their family members. 

The current health plan excludes treatments for gender dysphoria, including hormone therapy, counseling, and surgery, which the lawsuit argues are medically necessary and oftentimes life-saving treatments for individuals with gender dysphoria. Withholding coverage from these individuals is discrimination on the basis of sex and in violation of the Patient Protection and Affordable Care Act, the lawsuit alleges. 

“This is clearly unlawful discrimination that jeopardizes the health of hardworking state employees and their families. It stigmatizes them and brands them as second-class,” said Lambda Legal attorney Taylor Brown. “I am a transgender woman, born and raised in North Carolina and an alumna of UNC-Chapel Hill. This kind of targeted discrimination is shameful to me personally and it does not represent the true values of this state or North Carolinians.”