ATLANTA — A reality TV personality fought and won a battle against the University System of Georgia for transgender rights, but he said Monday the war for health care benefits for the trans community is not over.  

The University System of Georgia settled a lawsuit last week with the employee that will spread health care benefits to transgender individuals across the entire university system in the state — including all 26 universities and the public library system.

Skyler Jay — who became a public figure after appearing on Netflix’s series “Queer Eye” — sued the University of Georgia for denying reimbursement for his gender-affirmation surgery in 2017. Plaintiffs in the lawsuit include the Board of Regents of the University System of Georgia and UGA’s administrators and healthcare providers, including Metlife and Blue Cross Blue Shield of Georgia.

On the heels of that settlement, a sheriff’s deputy filed a lawsuit in federal court against a Georgia county for refusing health insurance coverage for gender-affirmation surgery.

Despite federal anti-discrimination protections, some private health care insurance plans still include exclusionary provisions for funding transgender-related medical care.

Jay was a former student at University of Georgia and when hired full-time as a catering and banquets manager, said he was “shocked” when he was unable to find answers on what benefit package best covered his trans-related care.

“I was even more shocked when I finally made it to the main HR department with someone who slid a piece of paper across the desk, with the trans exclusion highlighted,” Jay told CNHI. “It didn’t matter the benefits package I chose because the care I was seeking would not be covered regardless.”

There was a clear contradiction between the university’s anti-discrimination and anti-harassment policy which includes gender discrimination and the exclusion of transgender health insurance, he said.

“They were holding two different legal documents, saying at face value ‘we are an inclusive institution and we are not going to discriminate on these basis’ we are going to protect you,’ he said, “and then on another official document they were explicitly discriminating.”

After initial court proceedings, Jay’s lawyers warned him if they proceeded to court, they did not expect a favorable ruling.

But deciding to take the settlement or push further for a ruling, Jay said, was one of the hardest decisions he’s ever had to make. 

“Unfortunately, a federal ruling on trans-related care is not going to come from the South first,” Jay said. “If I had continued to push for a circuit ruling and gotten a bad ruling, it would have been devastating for the trans community. My willingness to help all people could have potentially harmed far more than helped.”

Jay accepted the settlement and was awarded $100,000 in damages and removal of the transgender health care exclusion from USG’s employee health plans, according to Noah Lewis, Jay’s attorney.

“I have trans employees who work for me, I know trans people who work within my university. I know people who work at other universities in the system. I know people with trans children who work within the system that I could help directly and immediately,” Jay said about the settlement. “I was still able to impact my state and the University System of Georgia in a great way. So it is still a win, but no, the war is not over.”

Successful cases regarding trans-related health care have been won in other states, Lewis said, but people in the South “are being left behind.” Lewis is hopeful Jay’s case will pave the way for others.

“We had two goals: to get the exclusion removed for everybody but to also create legal precedent so that other employers would follow suit,” Lewis told CNHI. “Of course, actions speak louder than words and the fact that they settled it, indicates that the university system thought this was the right thing to do, if nothing else.”

Federal law protects discrimination based on sex and gender, but private employer health care plans can set their own terms. The federal government removed exclusionary policies in its health care for employees as well as within Medicaid plans.

“We’re kind of doing clean-up work surrounding private employers…” Lewis said. “It’s these self-funded plans, when the employer itself is paying out the claims and setting the terms of the plan — that’s where we are seeing the most exclusions remaining.”

Individuals like Anna Lange, he said, still face exclusions.

Perry, Georgia Sheriff’s Deputy Sgt. Anna Lange, was denied employer coverage of gender-affirmation surgery because of the same type of exclusion by her employer. Lange has filed a lawsuit against Houston County with Lewis as counsel.

Lange has worked for the department since 2006 and medically requires further gender-transition treatment to combat diagnosed gender dysphoria.

Court documents say that until 2017, Lange wore male clothing and went by her male birth name. After coming out as transgender — identifying as female rather than her male sex assigned at birth — she informed her employer “that she would begin wearing typical women’s clothing, using her female name, Anna, going by female pronouns and otherwise being openly female at work.”

But the private health care plan for the county excludes gender dysphoria and its treatments. Lange paid nearly $7,000 out-of-pocket for top-surgery but needs further gender reassignment procedures to treat her gender dysphoria.

In February, Lange asked the Houston County Board of Commissioners to waive the exclusion, according to court documents, which they declined.

“Excluding ‘sex change’ treatments is, by definition, an exclusion of gender-transition treatments,” the lawsuit says. “Only services undertaken for the exclusive purpose of changing external sex characteristics from male to female and vice versa are excluded. Thus, the Exclusion targets employees like Sgt. Lange because they are transgender.”

Lange is seeking removal of the exclusionary policy and damages.

“I think people may not realize that these cases have all been successful when they’ve gone to a ruling — this has been found to be discrimination…” Lewis said. “We’re at this kind of weird point that it’s so obviously discrimination that people are settling them, but we still have to keep bringing these cases.”

We will continue to see these cases until there is a federal ruling, Jay said.

“Even though this was a challenge — arguably one of the most difficult things I’ve ever been through in my life,” Jay said, “I hope it inspires people to continue to move forward with their cases and appeals because there’s no way that changes are going to be made without people stepping forward and being willing to take this on.”