Appeals Court Upholds Gender Transition Surgery Exclusion
On September 9, 2025, the Eleventh Circuit Court of Appeals ruled in Lange v. Houston County, Georgia that excluding coverage for gender transition surgery from an employer health plan did not facially violate Title VII civil rights.
The 11–5 en banc decision relied heavily on the U.S. Supreme Court’s recent ruling in United States v. Skrmetti.
Go Deeper:
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Title VII prohibits discrimination in employment, including benefits, on the basis of sex.
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Many courts have found that excluding gender dysphoria treatments constitutes unlawful sex discrimination.
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The Eleventh Circuit’s reversal signals a departure from that trend, though the case may be appealed to the Supreme Court.
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Separate from Title VII, exclusions may also face challenges under:
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§1557 of the Affordable Care Act
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The Mental Health Parity and Addiction Equity Act (MHPAEA)
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Both laws have seen shifting interpretations under different administrations, adding further uncertainty.
Employer Compliance Options / Considerations:
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Employers may consider exclusions or restrictions on gender dysphoria treatments and drugs, but doing so carries legal risks.
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Title VII claims are not fully settled — the issue could return to the Supreme Court.
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Employers should consult legal counsel before making plan changes, and ideally secure representation in case of a challenge.
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Similar rulings (e.g., Christian Employers Alliance v. EEOC) show that the law remains unsettled and may vary across jurisdictions.
Potential Impact to Employers:
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Employers in the Eleventh Circuit may feel more comfortable implementing exclusions, but risk remains if the issue reaches the Supreme Court.
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Employers outside the Eleventh Circuit should not assume the same outcome — other courts may rule differently.
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Plan restrictions related to gender dysphoria treatment should only be considered with legal backing and careful risk assessment.