Case: Lange v. Houston County, Georgia
5:19-cv-00392 | U.S. District Court for the Middle District of Georgia
Filed Date: Oct. 2, 2019
Case Ongoing
Clearinghouse coding complete
Case Summary
This is a challenge to a denial of insurance coverage for gender dysphoria care for a transgender employee.
On October 2, 2019, a transgender woman and twenty-two-year veteran law enforcement officer employed as a Deputy Sheriff in Houston County filed this lawsuit in the United States District Court for the Middle District of Georgia. The plaintiff sued Houston County, Georgia, the Houston County Board of Commissioners, and the Director of Personnel. Represented by Cooper, Barton & Cooper, Willkie Farr & Gallagher LLP, Transgender Legal Defense Education Fund, Inc., and Quinnipiac University School of Law Legal Clinic, the plaintiff alleged that she was denied coverage to treat her gender dysphoria under Houston County's insurance plan and that the plan specifically excludes coverage for gender-transition treatments, including "drugs for sex change surgery" and "services and supplies for a sex change". The complaint asserted that the plaintiff requires medically necessary gender-transition treatment including hormone therapy and surgery due to her gender dysphoria, the health plan's exclusion forces her to pay out-of-pocket or forego treatment despite covering other medically necessary services. The plaintiff repeatedly requested removal of the exclusion, but the defendants refused and reaffirmed their commitment to maintain it. The plaintiff brought claims under Section 1983, Title VII, the Americans with Disabilities Act (ADA), and state law, and sought declaratory and injunctive relief, damages, and attorneys' fees.
On November 22, 2019, the plaintiff filed a motion for preliminary injunction.
On December 3, 2019, the defendants filed a motion to dismiss the complaint and a motion for judgment on the pleadings.
On February 12, 2020, the plaintiff filed a letter regarding the intent to file a motion for leave to amend the complaint.
On March 23, 2020, the court stayed the pending motion for preliminary injunction and motion to dismiss until the plaintiff's motion to amend was resolved.
On April 10, 2020, the parties stipulated regarding the amended complaint, motion for preliminary injunction, and dispositive motions.
On April 10, 2020, the plaintiff filed an amended complaint and another motion for preliminary injunction. The amended complaint added two new defendants while removing one. The Director of Administration and the Sheriff were added, while a County Commissioner was removed from the lawsuit. In addition, the amended complaint added an additional Equal Employment Opportunity Commission (EEOC) charge filed against the Sheriff's Office in February 2020, a November 2019 board meeting where commissioners voted to maintain the transgender exclusion for 2020, and additional background information about the county's risk pool membership and federal grant funding. A new sixth cause of action was added against the Sheriff that alleged unlawful discrimination under Section 504 of the Rehabilitation Act and the existing Americans with Disabilities Act (ADA) claims were consolidated and reorganized to specify which defendants each claim targeted.
On May 11, 2020, the Sheriff filed a motion to dismiss for lack of jurisdiction, and the remaining defendants filed another motion to dismiss.
On October 30, 2020, the court denied the Sheriff's motion to dismiss for lack of jurisdiction and granted in part and denied in part the other defendants' motion to dismiss. The court denied the Sheriff's sovereign immunity defense, finding the Sheriff's Office failed to demonstrate it was acting as an "arm of the state" when providing healthcare benefits. The court granted partial dismissal of several claims, including all ADA Title II and Rehabilitation Act claims, but allowed the plaintiff's Title VII and ADA Title I claims against the County to proceed, noting that Bostock v. Clayton County had foreclosed the defendants' argument that the health plan exclusion did not constitute sex-based discrimination. 499 F.Supp.3d 1258.
On December 22, 2020, the court denied the defendant’s motion for reconsideration. The County had previously challenged whether it could be considered Lange's employer under Title I of the Americans with Disabilities Act (ADA) and Title VII of the Civil Rights Act of 1964, specifically regarding claims of discrimination in healthcare plan benefits. The court found that because the Sheriff had delegated employee health benefits to the County, and Lange's complaint alleged discriminatory exclusions in that healthcare plan, the County's conduct fell within the scope of that delegation. The court rejected the County's arguments for reconsideration, explaining that reconsideration requires either an intervening change in law, new evidence, or clear error of law, and that the County had merely restated prior arguments rather than demonstrating clear error. As a result, the case proceeded with Houston County remaining as a defendant for claims related to its role in providing employee health benefits. 2020 WL 7634054.
On May 19, 2021, the plaintiff filed a motion to withdraw preliminary injunction.
On November 3, 2021, all of the defendants filed motions for summary judgment and the following day, the plaintiff filed a motion for summary judgment.
On December 22, 2021, the parties filed responses to the opposing motions for summary judgment.
On June 2, 2022, the court ruled on the cross motions for summary judgment. The court granted the plaintiff's partial summary judgment on her Title VII sex discrimination claim and found that under Bostock v. Clayton County, the exclusion constituted facial sex discrimination by denying coverage based on transgender status. However, the court dismissed the plaintiff's Americans with Disabilities Act (ADA) claim and ruled that gender dysphoria falls under the statute's "gender identity disorders" exclusion, and barred damages claims against the Sheriff individually under Eleventh Amendment immunity. The equal protection claim would proceed to trial due to material factual disputes regarding discriminatory intent. 608 F.Supp.3d 1340.
On June 16, 2022, the defendants filed a motion for interlocutory review under 28 U.S.C. § 1292(b) and sought certification for an interlocutory appeal. ⁻
On August 18, 2022, the court denied the motion to certify the court's order for interlocutory review. The court reasoned that interlocutory appeals are a "rare exception" with a strong presumption against them, and the defendants' proposed questions did not involve controlling questions of law with substantial ground for difference of opinion.⁻ The court found that the defendants merely disagreed with the Court's application of settled law rather than raising pure questions of law, and scheduled the trial on damages for the Title VII claim.
In September 2022, the parties entered the trial stage. On September 26, 2022, the court held a jury trial. On September 27, 2022, the jury returned a verdict for the plaintiff, finding that she suffered emotional pain and mental anguish as a result of the Exclusion and that she should be awarded $60,000.
On October 3, 2022, the court ordered permanent injunctive and declaratory relief. The court had previously granted summary judgment in the plaintiff's favor on her Title VII of the Civil Rights Act of 1964 claim and found that the health plan exclusions for sex change surgery and related services violated federal law. Based on these earlier findings, the court granted comprehensive relief including a declaration that the exclusions violate Title VII, a permanent injunction against their enforcement, and an order requiring the defendants to direct processing of the plaintiff's vaginoplasty claims under the 2019 health plan terms. While the Title VII claim was resolved in the plaintiff's favor, her Equal Protection claim remained pending for trial.
On October 21, 2022, the defendants filed a notice of appeal to the United States Court of Appeals for the Eleventh Circuit.
On October 31, 2022, the district court stayed the October 3 order pending the defendants' appeal.
On November 4, 2022, the Sheriff filed an appeal to the United States Court of Appeals for the Eleventh Circuit (22-13626-DD). The parties submitted their briefs in early 2023 and oral argument was scheduled for November 14, 2023.
On November 11, 2022, the plaintiff filed a response to the motion to stay pending appeal.
On November 17, 2022, the court granted the defendants' motion for continuance of the jury trial.
On January 13, 2023, the appellant filed a brief, and on March 15, 2023, the appellee filed its brief.
On March 1, 2023, because the defendants' motion for stay was resolved the court lifted the stay of the injunction.
On November 14, 2023, the appellate court heard oral argument on this matter.
On May 13, 2024, the appellate court affirmed the trial court's decision. The Eleventh Circuit applied Bostock v. Clayton County and held that the exclusion constituted facial discrimination against transgender individuals because it denied healthcare coverage that only transgender persons would seek. The court also determined that Houston County was liable under Title VII as an employer/agent due to its delegated control over health insurance provision. Judge Brasher dissented, arguing that the policy excluded certain procedures rather than discriminating against transgender people and that Bostock did not apply because the exclusion did not turn on an individual's sex. 101 F.4th 793.
On June 3, 2024, the defendants filed a petition for rehearing en banc.
On August 15, 2024, the court ordered that this appeal would be reheard en banc and vacated the panel opinion. 110 F.4th 1254.
Over the next few months, several amicus briefs were filed. On October 30, 2024, the United States Department of Justice, Civil Rights Division, filed an amicus curiae brief. The Department of Justice urged the court to affirm the district court's summary judgment ruling that found Houston County's health insurance plan facially discriminates based on sex by excluding coverage for "services and supplies for a sex change" and related treatments when medically necessary for transgender employees. The brief argued that this exclusion violates Title VII because the same medical procedures would be covered for other medical purposes, relying heavily on the Supreme Court's decision in Bostock v. Clayton County. The case involved plaintiff's denial of coverage for a medically necessary vaginoplasty, which the health plan would have covered if provided for a different medical purpose. This en banc appeal came after a divided panel initially affirmed the district court's ruling, but the full Eleventh Circuit granted review of the case.
On February 4, 2025, the Eleventh Circuit held oral argument en banc.
On April 4, 2025, the Department of Justice filed a motion to withdraw as counsel without explanation.
On September 9, 2025, the appellate court issued an en banc opinion concerning whether an insurance policy's exclusions for gender-affirming care violated Title VII. The en banc court, in an opinion authored by Circuit Judge Brasher, relied heavily on the Supreme Court's recent decision in United States v. Skrmetti to conclude that the plan's exclusions did not constitute facial discrimination under Title VII because they were based on medical use rather than protected characteristics⁻. The court reversed the district court's grant of summary judgment in favor of the plaintiff and remanded for further proceedings. 152 F.4th 1245.
On September 24, 2025, the appellate court reversed, vacated, and remanded the district court's grant of a motion for summary judgment.
As of April 2026, this case is ongoing.
Summary Authors
Haleigh Knowles (4/18/2026)
People
For PACER's information on parties and their attorneys, see: https://www.courtlistener.com/docket/16513897/parties/lange-v-houston-county-georgia/
ARKLES, Z GABRIEL (Georgia)
BARRY, KEVIN (Georgia)
BARTON, KENNETH E (Georgia)
ARCHER, T JOSHUA (Georgia)
Baldwin, Anna Marks
Documents in the Clearinghouse
Docket
See docket on RECAP: https://www.courtlistener.com/docket/16513897/lange-v-houston-county-georgia/
Last updated April 20, 2026, 3:08 a.m.
Case Details
State / Territory:
Case Type(s):
Healthcare Access and Reproductive Issues
Special Collection(s):
Trump Administration 2.0: Reversing Course on Existing Litigation
Key Dates
Filing Date: Oct. 2, 2019
Case Ongoing: Yes
Plaintiffs
Plaintiff Description:
A transgender woman and veteran law enforcement officer employed as a Deputy Sheriff in Houston County
Plaintiff Type(s):
Public Interest Lawyer: Unknown
Filed Pro Se: No
Class Action Sought: No
Class Action Outcome: Not sought
Defendants
County
Houston County, Georgia
Defendant Type(s):
Facility Type(s):
Case Details
Causes of Action:
Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.
Section 504 (Rehabilitation Act), 29 U.S.C. § 701
Title VII (including PDA), 42 U.S.C. § 2000e
Constitutional Clause(s):
Due Process: Substantive Due Process
Other Dockets:
Middle District of Georgia 5:19-cv-00392
U.S. Court of Appeals for the Eleventh Circuit 22-13626
Available Documents:
Outcome
Prevailing Party: Plaintiff OR Mixed
Relief Sought:
Relief Granted:
Source of Relief:
Amount Defendant Pays: $60,000
Issues
Discrimination Basis:
Affected Sex/Gender(s):
LGBTQ+:
Medical/Mental Health Care:
Case Summary of Lange v. Houston County, Georgia, Civil Rights Litig. Clearinghouse, http://www.dev.clearinghouse.net/case/48037/ (last updated 4/18/2026).