HOUSTON COUNTY, Ga. — The United States Justice Department is asking to join a legal battle between a transgender sheriff deputy and the Houston County Sheriff's Office, according to a filing in the 11th Circuit Court of Appeals.
The case centers on Anna Lange, formerly a transgender sheriff deputy with the Houston County Sheriff's Office who alleges that the office's health insurance policy is discriminatory against transgender people.
Her doctors recommended "medically necessary" care for gender-reassignment surgery.
But the sheriff's office's health insurance policy explicitly excludes "services and supplies for a sex change and/or reversal of a sex change" and "drugs for sex change surgery," according to the DOJ's filings.
Back in 2022, a jury sided with Lange and awarded her $60,000 for pain and suffering and said that the sheriff's office could not deny transgender patients coverage for medical services that would otherwise be approved in other medically necessary contexts.
The procedure, which would have cost $20,000, was rejected by the county, the filings said. Over the course of the case, the county had paid $1 million in legal fees, according to Lange's attorneys.
Now, Houston County is appealing that 2022 ruling and taking the case to U.S. Court of Appeals for the 11th Circuit.
The Department of Justice asked to join the case as an amicus curiae — or friend of the court — and present oral arguments on Lange's side.
In the court filings, the DOJ argues that since the policy specifically singles out gender transition and gender-affirming care, the policy is in violation of the Patient Protection and Affordable Care Act. Those laws ban sex discrimination in health programs that receive federal money.
They argue that the policy is in violation of the Title VII of the Civil Rights Act of 1964.
The DOJ's filing in the 11th Circuit Court of Appeals notes that the county's health care provider, Anthem Blue Cross Blue Shield, recommended the county remove the exclusions because of that, but that the county rejected their recommendation.
"The case raises the question whether an employer violates Title VII of the Civil Rights Act of 1964... if it denies health insurance coverage for medically necessary gender-affirming care, when the care would otherwise be covered if provided for some other medically necessary reason," the Justice Department wrote in the motion to participate in Oral Arguments.
The Justice Department argues that many of the procedures Lange's doctors recommended would have been covered by Blue Cross Blue Sheild "if it were provided for some other medically necessary purpose," they wrote.
"Thus, given the 'undisputed' fact that the challenged provisions of the plan deny coverage 'only for transgender members,' the court held that the plan facially discriminates based on sex," the DOJ wrote.
Lange joined the Houston County Sheriff's Office in 2006 and had been promoted to sergeant in 2012, according to the court filings. At the time, Lange presented as a male.
But a few years later, the filings say, Lange was diagnosed with Gender Dysphoria — the condition where one's sex assigned at birth conflicts with their gender identity — and she began to present as female in 2017.
Around that time, Lange requested to present herself as a female and wear a female uniform, which Sheriff Cullen Talton granted. He told her he "did not 'believe in sex changes,'" which he later reiterated at a staff meeting, according to the filing.
In the DOJ's brief, Lange paid out of pocket for hormone replacement therapy and surgery to "feminize her chest" because she knew the county's health insurance policy would not cover those treatments.
But at the request of her endocrinologist, two psychologists and a surgeon, Lange sought out "genital surgery" and requested that the county's health insurance cover the surgery.
Under the insurance company's guidelines, Lange's surgery was considered "medically necessary," so Blue Cross Blue Shield originally approved coverage for the treatment, the filing said.
But later, Houston County officials who administer the county's health plan stepped in, pointing to the county's policy excluding gender-affirming care. Because of the policy, the county denied coverage for Lange's surgery.
Attorneys for Lange and the Department of Justice point to how mastectomies — the surgery where a person's breast is removed — are covered when the procedure is considered necessary in cancer treatment but not for gender-affirming care.
They also point to how the county's health insurance policy pays for hormone replacement therapy when it is for use in menopause but it would not cover the procedure for an employee's gender transition.
Because of the decision to deny Lange coverage on the basis of her gender identity, the previous judge sided with her saying that the policy was discriminatory, the DOJ wrote. Now, Houston County is hoping to overturn that decision in the U.S. Court of Appeal in the 11th Circuit.
Amicus Curiae enter cases when they believe they have a vested interest in the outcome of the case.
In their request to participate in oral arguments, the Justice Department says they have a "strong interest in the proper application of Title VII," which is the section of the Civil Rights Act of 1964 that protects employees and job applicants from employment discrimination based on race, religion, national origin and sex.
The DOJ is also joining the case to help clarify another legal question of interest to them.
While Lange worked for the Houston County Sheriff's Office, the government of Houston County actually managed the office's health insurance.
In the previous case, the court found that Lange had grounds to sue Houston County "because 'it had 'acted as the sheriff's agent.'"
The DOJ is arguing that the court should allow legal actions against third-party entities acting on behalf of an employer.
They say that the case law, policies from the U.S. Equal Employment Opportunity Commission and the text of Title VII all suggest that the policy "applies equally to private and public employers."
"Defendants contest the district court's ruling on policy grounds, arguing that it would represent 'expansive application' of the statute to find that, in providing hand administering health insurance benefits for Sheriff's Office employees, the County acted as an agent of the Sheriff's Office," the DOJ argued. "But such a finding is hardly remarkable and follows from a straightforward application of Title VII's text and ordinary agency principles."