A group of federal employees has filed a proposed class-action lawsuit challenging the Trump administration’s decision to remove most insurance coverage for gender-affirming healthcare from federal employee health plans.
Five anonymous government workers filed the case Monday in federal court in Washington, D.C., against the Office of Personnel Management, or OPM. They argue that excluding treatments when they are provided for gender transition amounts to sex discrimination under Title VII of the Civil Rights Act.
The lawsuit has not yet been certified as a class action, and a court has not ruled that the administration’s policy is unlawful. The case is listed as Doe v. Kupor in the U.S. District Court for the District of Columbia.
OPM instructed insurers participating in the Federal Employees Health Benefits and Postal Service Health Benefits programs to stop covering chemical and surgical interventions intended to modify a person’s sex characteristics, including services described as gender transition care.
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The directive applies regardless of age and includes treatments such as hormone therapy and certain surgeries when they are provided for gender transition. The same medicines or procedures may still be covered when used for other medical conditions.
Counseling for diagnosed or possible gender dysphoria remains covered, including counseling provided by licensed faith-based professionals. For the 2026 plan year, insurers were also required to create case-by-case exceptions for some patients who had already started hormonal or surgical treatment.
The plaintiffs say that distinction is discriminatory because treatments available for other medical purposes are excluded when prescribed as gender-affirming care. They are represented by the Human Rights Campaign Foundation and the Washington law firm Correia & Puth.
According to the lawsuit, affected workers and their family members have received bills for routine appointments, blood tests, medication and follow-up care that their insurance previously covered. Some plaintiffs say they have used savings, delayed procedures or considered leaving federal employment because of the additional costs.
Those claims remain allegations that will need to be supported through court filings, testimony and insurance records.
The federal benefit programs cover approximately 8.3 million employees, retirees and dependents. Researchers at the Williams Institute at UCLA School of Law estimate that between 39,400 and 57,800 transgender people may be enrolled, although the institute acknowledges that no database directly records the exact number.
Its lowest estimate is 39,400, while its middle estimate is approximately 45,650. The researchers based the projections on population surveys, federal workforce data and assumptions about participation among employees, retirees and dependents.
OPM has defended its authority to determine which services federal health plans must cover. The agency says the policy is intended to protect taxpayer-funded benefits, maintain responsible spending and establish consistent standards across participating insurers.
OPM has also pointed to a March decision by the Equal Employment Opportunity Commission that supported the government’s authority to permit restrictions on gender-transition coverage. However, that administrative decision does not prevent employees from asking a federal court to review the broader policy and its application.
The lawsuit’s central legal question is whether the exclusion should be treated as an ordinary insurance-benefit decision or as unequal treatment based on sex.
The plaintiffs argue that federal workers receive the health plan as part of their employment compensation and that denying coverage specifically to transgender and gender-nonconforming employees violates workplace civil-rights protections.
The administration is expected to argue that OPM has broad authority to design federal benefits and that the policy applies to particular procedures and purposes rather than excluding people from the insurance program entirely.
Medical organizations have also become part of the wider policy dispute. The American Medical Association recognizes some medical and surgical treatments for gender dysphoria as medically necessary when selected through shared decision-making between a patient and physician. It supports insurance coverage based on generally accepted standards of care.
That position does not mean every patient is eligible for every treatment. Decisions may depend on age, diagnosis, individual health circumstances, informed consent and clinical evaluation. Critics of the treatments continue to question their risks and evidence base, particularly when minors are involved.
The OPM exclusion, however, reaches adults as well as children and applies across federal and postal employee health plans.
The practical consequences extend beyond the national debate over transgender policy. Federal employees select jobs partly on the basis of salary, retirement and health benefits. A government decision removing coverage for an ongoing treatment can create unexpected expenses for workers who believed that care would remain included.
The court will therefore be asked to evaluate not only the administration’s policy authority but also whether the government can provide different insurance coverage for the same medicines or procedures depending on why they are prescribed.
Why It Matters
The case could determine whether tens of thousands of federal workers, retirees and family members must continue paying out of pocket for gender-affirming healthcare.
A ruling against OPM could require the government to restore coverage or reconsider how exclusions are written. A ruling supporting the administration could strengthen presidential authority to reshape federal employee health benefits and influence similar disputes involving other public insurance programs.
The outcome could also affect recruitment and retention if employees conclude that their healthcare coverage may change substantially after a new administration takes office.
What Comes Next
The federal government will be given an opportunity to respond and may ask the court to dismiss the case before it reaches a full trial.
The plaintiffs are expected to seek class-action status so that the case can represent a broader group of federal and postal employees, retirees and dependents. The judge will decide whether they meet the legal requirements for proceeding as a class.
Until the court issues an order, the current coverage restrictions remain in effect. Further filings may reveal the exact relief requested, additional details about the plaintiffs’ medical expenses and whether they will seek an emergency injunction restoring coverage while the lawsuit proceeds.
