Federal employees seek restoration of gender-affirming care coverage

A group of five federal employees is urging a federal court to overturn the Trump administration’s elimination of gender-affirming care coverage in the government’s health insurance systems.

Employees suing the Office of Personnel Management over the coverage ban filed a preliminary injunction request on Thursday, seeking to restore the benefit in the Federal Employees Health Benefits (FEHB) program and Postal Service Health Benefits (PSHB) program.

Without coverage of gender-affirming care, plaintiffs alleged that thousands of federal employees, retirees and their family members would face irreparable harm.

“This is a case about the federal government refusing to provide its workers and their loved ones with the basic healthcare it has promised them,” the request, filed in the U.S. District Court for the District of Columbia, reads.

The preliminary injunction request comes just days ahead of the start of Open Season on Monday, when federal employees and annuitants will have the opportunity to change their plan options ahead of the upcoming plan year.

“Transgender beneficiaries, including plaintiffs, navigating open enrollment are presently facing unique, concrete and imminent challenges to securing medically necessary treatment and procedures recommended by their care providers for 2027,” the court filing states.

The lawsuit, initially filed in August, alleges that OPM’s reduction of gender-affirming care coverage violates Title VII of the 1964 Civil Rights Act. The coverage ban is discriminatory against transgender plan members, plaintiffs allege, as FEHB carriers can and still do cover gender-related care for other purposes, such as getting breast implants after a plan member has a mastectomy.

Gender-affirming care coverage has already been largely reduced in the FEHB and PSHB programs. For the 2026 plan year, OPM directed carriers to cease covering most gender-affirming care for plan members, but still allowed coverage of counseling services, as well as case-by-case exceptions for those who were “mid-treatment.”

It’s a sharp departure from the Biden administration’s previous expansion of gender-affirming care coverage requirements for FEHB and PSHB carriers.

For 2027, OPM is further reducing the benefit by ending coverage for enrollees with diagnosed gender dysphoria who are mid-treatment and seeking hormonal or surgical care. Starting in January, FEHB and PSHB enrollees will only see coverage of counseling services. OPM initiated its plan for a broader coverage ban through a call letter sent to health carriers in late March, which described gender-affirming care as “sex rejection” treatment.

Plaintiffs in the case are seeking class certification, citing an estimate from the Williams Institute that between 39,400 and 57,800 transgender individuals, including employees, retirees and dependents, are enrolled under the FEHB and PSHB programs.

Gender-affirming care coverage, which OPM had allowed carriers to offer for years, was “critical” to many federal employees, plaintiffs said. While they already lost coverage beginning in 2026, the lawsuit argues, “the 2027 exclusion will continue that denial and, importantly, deepen its consequences.”

“OPM again expanded the exclusion without citing a single medical study or clinical finding to justify the change,” the lawsuit states.

An OPM spokesperson declined to comment for this story, citing an agency policy of not commenting on pending litigation.

Plaintiffs in the case say OPM’s blanket ban on coverage will prevent them from accessing critical treatment they need, as they cannot sustain the costs of paying for hormone therapy entirely out-of-pocket.

As a result, the employees are dealing with various symptoms and medical risks of not having access to gender-affirming care, including “intrusive thoughts, mental and emotional upheaval, and withdrawal,” as well as risking chronic fatigue, a loss of bone density and hot flashes from discontinued hormone replacement therapy (HRT), the court filing explains.

“All of these physical harms are compounded by the emotional and financial strain caused by the 2027 exclusion, which causes harm to plaintiffs that cannot be undone,” it states.

One of the plaintiffs, under the pseudonym Charlotte Coe, is a transgender woman who has served at the State Department for the last eight years. She experiences daily pain that’s difficult to manage due to a surgery complication. Although a corrective operation could permanently fix the issue, her surgeon won’t operate unless she has insurance coverage, according to the court filing. Without coverage, the procedure could cost tens of thousands of dollars.

“Restoring coverage would remove the barrier that currently prevents her from obtaining that treatment from her surgeon,” the court filing states. “The 2027 policy instead prolongs that barrier, requiring her to enter another plan year with the condition untreated and the cost of continuing care resting on her already strained finances.”

A second plaintiff, given the pseudonym Vanessa Voe, is a researcher at the Defense Department, and a transgender woman who has been in transition for several years. But after joining the federal workforce in August 2026, she lost insurance coverage for the treatment she had been relying on, the court filing states. Without the benefit, she will have to cut corners by rationing her treatment, effectively endangering her health, the lawsuit contends.

Federal employees involved in the lawsuit had initially filed a complaint with the Equal Employment Opportunity Commission, alleging that the coverage restrictions illegally discriminate against employees based on sex and disability.

After EEOC rejected the allegations and upheld OPM’s coverage limitations in March, plaintiffs began pursuing a class action lawsuit in federal district court. Law firms Correia & Puth and Cohen Milstein Sellers & Toll, as well as the Human Rights Campaign Foundation, are representing plaintiffs in their case.

“Denying critical care to federal employees and their families simply because they are trans is a clear, targeted attack on our community,” Human Rights Campaign Foundation and Correia & Puth said in a joint statement. “We took the administration to court, and obtaining a preliminary injunction would bring much-needed relief to our plaintiffs and class members who have suffered under this blatantly discriminatory mandate.”

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