The US district judge made the ruling in the case of four trans Wisconsin residents, who were challenging a 1997 provision that excluded coverage of “transsexual surgery” for Medicaid recipients.

Judge William Conley said on Friday, August 16, that the state’s Medicaid programme was discriminating against trans people by not covering trans healthcare.

The four trans people who filed the lawsuit argued that gender-affirming healthcare for trans people was medically necessary due to the medically recognised condition of gender dysphoria.

“There is now a consensus within the medical profession that gender dysphoria is a serious medical condition, which if left untreated or inadequately treated can cause adverse symptoms, such as anxiety, depression, serious mental distress, self-harm and suicidal ideation,” Conley wrote in his judgment, according to the Wisconsin State Journal.

In the 38-page ruling, Conley said that trans people in Wisconsin were being discriminated against on the basis of sex under the federal Affordable Care Act.

Conley’s ruling follows a temporary injunction against the provision that he issued last year.

Insurance companies that manage state Medicaid plans also “acknowledge that gender-confirming hormone and surgical treatments for gender dysphoria can be medically necessary”, Conley said.

Wisconsin is among nine US states that have explicit Medicaid exclusion for trans healthcare, according to the ruling, which also estimates the cost of gender-affirming treatments covered by Medicaid to be between $300,000 and $1.2 million per year.

Wisconsin spends $3.9 billion a year on its Medicaid programme.

Trump proposing nationwide rollback of trans healthcare.

On May 24, the Trump administration filed a 204-page proposed regulationthat would roll back healthcare protections for trans people.

The US Department of Health and Human Services (HHS) published the document proposing eliminating gender identity as one of the factors in healthcare and government policy.

The regulation would reverse changes made by the Obama administration and came as another knock to the transgender community.