Nevada Removes Discriminatory Ban on Medically Necessary Facial Surgery

Lambda Legal announced today that, as a result of a complaint filed last year with the U.S. Equal Employment Opportunity Commission (EEOC), the State of Nevada has removed its discriminatory exclusion on coverage for medically necessary facial surgery for transgender employees. Lambda Legal filed the complaint on behalf of Alexandra “Lexa” Baldwin, a transgender woman employed as an IT technician at the University of Nevada, Reno. As part of the settlement, Nevada will also pay $45,000 for the discrimination that Ms. Baldwin experienced.

“The removal of this discriminatory exclusion means that transgender employees can now access this medically necessary and life-saving care on equal terms as everyone else,” Lambda Legal Senior Counsel Peter Renn said regarding the change to the Nevada Public Employees’ Benefits Program. “The plan had covered medically necessary facial surgery for others, but it explicitly carved out transgender people from that coverage, even though it can also be medically necessary to treat gender dysphoria. Equal pay for equal work is something that we all expect, and that the law demands, but transgender workers were being shortchanged of critical health insurance coverage that others receive in exchange for their labor. This development fixes that basic unfairness.”

“It is a huge relief and a weight off my shoulders that the State will now finally allow me to access the medical care my health care providers have all agreed is medically necessary for me,” Lexa Baldwin said. “From picking up groceries to jogging in the evening to getting on a bus, your face is the very first thing that everyone sees and uses to determine your gender. But it can feel exhausting and, frankly, debilitating when your face does not match who you are and outs you as transgender. I confront this reality every single day with my head on a swivel, looking out for where harassment, discrimination, or violence may come from next.”

Lambda Legal Staff Attorney Nora Huppert added, “Being able to navigate everyday life and be recognized by others as a woman is not only medically necessary for Lexa, but it can also present an issue of basic safety, especially in light of the staggeringly high rates of discrimination and violence against transgender women. It is no exaggeration that this care can have life-or-death stakes for those who need it.”

Lexa Baldwin has worked at the University of Nevada, Reno (UNR) as an IT technician since 2019. She had previously served in the U.S. Marine Corps. and sustained an injury resulting in an honorable discharge. In 2018, Ms. Baldwin began her transition to living openly as a woman after a diagnosis of gender dysphoria, which is the clinically significant distress that can result from the discordance between one’s gender identity and birth-assigned sex. However, she encountered significant discrimination in the job market despite her IT qualifications, and she experienced several months of homelessness as a result, before ultimately securing employment at UNR.

As a state employee, Ms. Baldwin’s health insurance was provided through Nevada’s Public Employees’ Benefits Program (PEBP). Her plan contained a targeted exclusion for “certain procedures associated with gender dysphoria treatment” and categorically excluded facial surgery for transgender people.   Although her healthcare providers agreed that such treatment was necessary for Ms. Baldwin, she was denied coverage because of the exclusion. In February 2021, Lambda Legal filed a complaint against PEBP and the Nevada System of Higher Education with the EEOC based on the violation of federal and state laws prohibiting sex-based discrimination in employment. The EEOC issued determinations in May 2022 finding that there was reasonable cause to find that the government had engaged in unlawful discrimination. The government has now permanently removed the exclusion from its health insurance plans and has also agreed to pay Ms. Baldwin $45,000 for the discrimination she experienced.  

“I am relieved that the State has removed this exclusion and that, at long last, I will be able to get the medically necessary care that all of my health care providers agree that I need. Medically necessary care should be covered equally, just as it would be if I needed facial surgery because of an injury from serving in the Marines,” Lexa said. “I’m also happy that other transgender folks working for the State of Nevada will not have to go through what I went through and will have access to the care and the coverage they need to safely and successfully navigate life.”

The case is Baldwin v. Nevada System of Higher Education and Public Employees’ Benefits Program.

Lambda Legal lawyers on the case include Peter Renn, Nora Huppert, and Kell Olson.  Pro bono co-counsel were Adam Bult and Travis Chance of Brownstein Hyatt Farber Schreck, LLP.