Hennepin County District Court File No. 01013967
Considered and decided by Lansing, Presiding Judge, Peterson, Judge, and
The definition of "gender reassignment services" in Minn. Stat. § 256B.0625, subd. 3a (2002), includes gender reassignment surgery, hormone therapy, treatment for gender dysphoria, and chemical-dependency treatment required to begin hormone therapy.
The opinion of the court was delivered by: Wright, Judge
After respondent Paula Hare was denied coverage for gender reassignment surgery by UCare Minnesota (UCare), her health plan, she appealed to the health plan's contracting agency, the Minnesota Department of Human Services (DHS), which affirmed UCare's decision. Hare sought judicial review in district court, and the district court reversed DHS's order. DHS now appeals, arguing that the district court erred when it ruled that (1) Minn. Stat. § 256B.0625, subd. 3a (2002), the provision addressing coverage for gender reassignment, is unconstitutionally vague and (2) DHS failed to follow rulemaking procedures when it adopted a definition for "gender reassignment services" in Minn. Stat. § 256B.0625, subd. 3a. Because we conclude that Hare's treatments for gender dysphoria and for chemical dependency required to begin hormone therapy are "gender reassignment services" under Minn. Stat. § 256B.0625, subd. 3a, we affirm.
Since she was a small child, respondent Paula Hare, although born male, has had the desire to be female. In mid-1997, Hare consulted with Dr. Sharon Satterfield, a gender-identity-disorder specialist, seeking treatment for gender dysphoria.*fn1 Dr. Satterfield concluded that, because Hare suffered from a substance-abuse problem, hormone drug therapy and gender reassignment surgery, both necessary for the physical transformation from male to female, were not appropriate unless Hare was free of chemicals for one year. Following her initial consultation with Dr. Satterfield, Hare successfully completed chemical-dependency treatment and participated in group and individual therapy for gender dysphoria. Under Dr. Satterfield's care, Hare began hormone therapy in September 1998.
Hare is a member of the MinnesotaCare health program and received services from UCare, a health plan that provides services to MinnesotaCare participants under contract with DHS. In December 1998, Hare began treatment for gender dysphoria with Dr. William Robiner of the Fairview University Medical Center. On August 21, 2000, Dr. Robiner requested authorization from UCare for Hare to undergo gender reassignment surgery.
MinnesotaCare will pay for gender reassignment surgery only if a person began receiving "gender reassignment services" prior to July 1, 1998. Minn. Stat. § 256B.0625, subd. 3a (2002). UCare denied Hare's request for coverage for gender reassignment surgery based on its determination that Hare, having begun hormone therapy in September 1998, had not commenced "gender reassignment services" before July 1, 1998. Hare appealed this decision to DHS, and an administrative referee affirmed UCare's decision.
Hare then sought judicial review. Before the district court, Hare argued that Minn. Stat. § 256B.0625, subd. 3a, (1) was misinterpreted by DHS; (2) violates her constitutional right to privacy and bodily integrity; and (3) violates her equal protection rights. The district court requested additional briefing on whether Minn. Stat. § 256B.0625, subd. 3a, is void for vagueness and whether DHS properly adopted the definition of "gender reassignment services." Because there is no statutory definition of "gender reassignment services," the district court ruled that Minn. Stat. § 256B.0625, subd. 3a, is unconstitutionally void for vagueness. The district court also concluded that, because DHS failed to adopt a definition of "gender reassignment services" by rule, its application to Hare is void. DHS now appeals.
Did the district court err in determining that MinnesotaCare is obligated to pay for gender reassignment surgery where, before July 1, 1998, the patient received services that included only treatment for gender dysphoria and ...