Mariah L. sought coverage for transition-related healthcare as a 20-year-old transgender woman in foster care in New York City. Mariah’s doctors have all agreed that sex reassignment surgery is medically necessary for her. In New York, the Administration for Children’s Services (ACS) has a duty to provide and pay for all necessary medical care and treatment for children placed in foster care, but ACS has refused to provide Mariah with the medical care that she needs.