The ACLU and the ACLU of South Dakota filed a federal suit on behalf of Terri Bruce against the state of South Dakota because it denies transgender employees health insurance coverage for medically necessary transition-related health care.

Terri Bruce has worked at the South Dakota State Historical Society Archaeological Research Center for nearly ten years. The suit alleges the South Dakota State Employee Health Plan (SDEHP) policy of refusing to cover medical care required by transgender people is discrimination and violates federal and state law.

Bruce is a man who is transgender, meaning that while the sex assigned to him at birth was female, he has a male gender identity. He was diagnosed with gender dysphoria, a serious medical condition marked by persistent and clinically significant distress caused by incongruence between an individual’s gender identity and that individual’s sex designated at birth. As a result of the plan's discriminatory exclusion, Bruce has been blocked from receiving medically necessary chest reconstruction surgery prescribed by his physician in accordance with the widely accepted standards of care for treating gender dysphoria. According to the Plan administrator, "while [the surgery] may be medically necessary" the Plan "specifically excludes coverage for Services or drugs related to gender transformation."

In the past, some public and private insurance companies excluded coverage for gender dysphoria (or “transition-related care”) based on the erroneous assumption that such treatments were cosmetic or experimental. Today, however, every major medical organization recognizes that such exclusions have no basis in medical science and that transition-related care is effective for the treatment of gender dysphoria.

After Bruce was denied coverage for transition related services, he was forced to pay out of pocket for treatments prescribed by his physician. Bruce filed a discrimination charge with the Equal Employment Opportunity Commission, and they found reasonable cause to believe that the SDEHP discriminates against Bruce on the basis of sex and authorized him to sue to the state health system.

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