Hazel Brashar was a 21-year old transgender woman on Medicaid in Oregon. She experienced debilitating dysphoria as a result of the male-appearing features of her face. Even leaving the house was a difficult task and often ended with severe panic attacks that forced Hazel to return home. Hazel’s treating providers all agreed that facial feminization surgery was medically necessary to treat Hazel’s gender dysphoria. Unfortunately, Oregon Medicaid specifically excluded coverage for facial feminization surgery and Hazel’s request for prior authorization was denied.

The National Center for Lesbian Rights and the Legal Aid Society of Oregon appealed the denial of coverage to the Office of Administrative Hearings. On September 16, 2016, the Administrative Law Judge determined that facial feminization surgery was not a cosmetic procedure and that those procedures were medically necessary to treat Hazel’s gender dysphoria. The ALJ nevertheless affirmed the denial due to coverage rules that are unique to Medicaid in Oregon.

The National Center for Lesbian Rights, along with Perkins Coie, appealed that ruling to the Oregon Court of Appeals. While the appeal was pending, the parties were able to resolve the dispute and the appeal was dismissed. Oregon Medicaid subseq uently began covering facial feminization surgery for transgender beneficiaries.