A federal court in Georgia ruled Thursday that employers who categorically exclude gender-affirming medical care from health insurance coverage violate federal law. 

Anna Lange, a transgender woman and sheriff’s deputy in Houston County, Georgia, sued in 2019 after she was denied coverage for a vaginoplasty in November 2018. 

The Sheriff’s Office provides health care coverage to employees through the county plan, which, beginning in 1998, excluded coverage for talk therapy related to gender dysphoria, gender-affirming hormone therapy and gender-affirming surgeries, according to the opinion released Thursday. 

Chief Judge Marc Treadwell, of the U.S. District Court for the Middle District of Georgia, wrote in the opinion that the exclusion “plainly discriminates because of transgender status,” and as a result violates Title VII of the Civil Rights Act of 1964, a federal law that prohibits employment discrimination based on race, sex, religion, national origin and other protected categories.

He pointed to evidence that showed Houston County’s health care plan, provided through Anthem Blue Cross and Blue Shield, would provide hormone therapy for menopause and surgery for breast cancer, but it would not provide the same procedures as treatment for gender dysphoria. 

“The undisputed, ultimate point is that the Exclusion applies only to transgender members, and it applies to Lange because she is transgender,” Treadwell wrote, citing a landmark Supreme Court decision in June 2020, which found that Title VII’s protection from discrimination based on sex also includes gender identity and sexual orientation discrimination. 

The opinion also noted that, in 2016, Houston County’s insurance broker, who acted as a liaison between the county and Anthem, informed the county that Anthem would no longer categorically exclude coverage for treatments related to gender dysphoria as a result of the Affordable Care Act’s Section 1557, which prohibits discrimination based on sex and other characteristics. 

“Despite Anthem’s recommendation to do so, the County chose not to accept the nondiscrimination mandate,” according to the opinion.

A representative for Houston County did not immediately return a request for comment.

Lange, who was represented in part by the Transgender Legal Defense and Education Fund, said in a statement that it’s “a huge relief to know that I can finally receive the medically necessary care that I was repeatedly and unfairly denied.”

“I can confidently move forward with my life knowing that gender affirming care is protected under federal law,” she said. “This decision is not only a personal victory, but a tremendous step forward for all transgender Southerners who are seeking insurance coverage for medically necessary care.”