Fletcher v. The State of Alaska, 443 F.Supp.3d 1024

Jennifer Fletcher, a transgender woman employed by the State of Alaska, was enrolled in the State’s self-funded health plan (AlaskaCare).
Fletcher was diagnosed with gender dysphoria and obtained gender-affirming surgery (vaginoplasty and mammoplasty) in Thailand in June 2017 after AlaskaCare denied coverage for transition-related surgery.
AlaskaCare’s pre-2018 plan expressly excluded treatments "related to changing sex or sexual characteristics," and 2018–2019 versions continued to exclude surgical procedures and prosthetic devices for sex change.
EEOC found Alaska’s categorical exclusion to be sex discrimination under Title VII and issued a right-to-sue; Fletcher sued the State under Title VII seeking a declaration and damages.
On cross-motions for summary judgment, the court held the Plan’s exclusion was facially discriminatory because it covered identical surgeries when needed to reaffirm natal sex but denied them when used to change natal sex, and granted Fletcher partial summary judgment.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether AlaskaCare’s blanket exclusion of transition-related surgery violates Title VII (disparate treatment)	Fletcher: exclusion discriminates based on sex/gender identity because natal sex determined coverage; denying identical surgery when sought to change sex is sex-based discrimination	State: exclusion is facially neutral and applies equally to all sexes, so no disparate treatment	Court: exclusion is facially discriminatory — treats natal males and natal females differently for the same medically necessary surgery; violates Title VII
Whether the Plan’s policy is a "facially discriminatory policy" permitting an inference of discriminatory motive	Fletcher: formal policy draws distinctions based on natal sex and thus is direct evidence of discrimination	State: policy is neutral because it excludes transition-related surgery for everyone regardless of sex	Court: comparing treatment of natal females vs natal males shows differential treatment based on sex; policy is facially discriminatory
Whether a BFOQ or other justification excuses the disparate treatment	Fletcher: no justification; disparate treatment not permitted	State: did not assert any BFOQ or lawful justification for the exclusion	Court: no BFOQ argued or available; disparate treatment not justified; judgment for Fletcher

City of Los Angeles v. Manhart, 435 U.S. 702 (U.S. 1978) (Title VII forbids treating individuals as mere components of a sex-based class)
Oncale v. Sundowner Offshore Servs., 523 U.S. 75 (U.S. 1998) (Title VII protects employees from sex-based disparate treatment)
Newport News Shipbuilding & Dry Dock Co. v. EEOC, 462 U.S. 669 (U.S. 1983) (fringe benefits are terms or conditions of employment under Title VII)
Hazen Paper Co. v. Biggins, 507 U.S. 604 (U.S. 1993) (liability depends on whether a protected trait actually motivated the decision)
Hively v. Ivy Tech Cmty. Coll. of Ind., 853 F.3d 339 (7th Cir. 2017) (comparative method: change only the plaintiff’s sex to test disparate treatment)
Boyden v. Conlin, 341 F. Supp. 3d 979 (W.D. Wis. 2018) (similar holding that excluding transition-related surgery is sex discrimination)
Frank v. United Airlines, Inc., 216 F.3d 845 (9th Cir. 2000) (disparate treatment permissible only if justified by a BFOQ)