Defining the Limits of Title VII: Eleventh Circuit Holds Health-Plan Exclusions for Gender Affirming Care Do Not Constitute Sex Discrimination

Lange v. Houston County

By Olivia R. Lee

In Lange v. Houston County, the Eleventh Circuit examined whether a Houston County employee health insurance plan’s exclusion of coverage for gender affirming surgeries and general care constituted discrimination in violation of Title VII of the Civil Rights Act of 1964. Specifically, the plaintiff, Anna Lange, contended that the Houston County Sheriff’s Office’s refusal to pay for her male-to-female sex change surgery under its employer-provided health insurance plan, which excluded “drugs for sex change surgery and services and supplies for a sex change and/or the reversal of a sex change,” indicated disparate treatment due to sex under Title VII. The district court held that the health plan’s exclusion of gender affirming care was, as a matter of law, facially discriminatory because it treated individuals differently based on their sex, and the court issued a permanent injunction barring the County from excluding sex change surgery from its insurance coverage. After a divided three-judge panel of the Eleventh Circuit initially affirmed the district court, the case was taken en banc, and the Eleventh Circuit ultimately determined that the insurance policy’s refusal to cover gender affirming care expenses did not violate Title VII, vacated . . .

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