Cruz v. Zucker, 14 Civ. 4456 (JSR), a class action lawsuit brought by The Sylvia Rivera Law Project (SRLP), The Legal Aid Society, and Willkie Farr & Gallagher LLP challenged New York’s refusal to provide funding for sex reassignment operations and other medical treatments, such as hormone therapy, through its Medicaid program. In response to the filing, the New York State Department of Health amended a regulation that had banned Medicaid coverage of all transgender and gender non-conforming care in early 2015. As a result, in March 2015 the state began covering hormone therapy and gender-reassignment surgery for adults.

But the revised regulation still excluded coverage for certain treatments deemed “cosmetic procedures” such as facial feminization surgery, breast augmentation, and tracheal shaving, which experts in the case testified are medically necessary for some patients to reduce the acute distress and suicide risk associated with gender dysphoria. The judge ruled that the amended regulation violated the federal Medicaid Act, requiring state Medicaid programs to provide coverage for medically necessary treatment and prohibiting plans from selectively denying coverage on the basis of diagnosis.