Plaintiffs Jami Claire, Kathryn Lane, and Ahmir Murphy are state employees who have been denied medically necessary treatment for gender dysphoria because of the state’s categorical exclusion of coverage for medically necessary gender-affirming care in health care plans provided to state employees. Some transgender people experience gender dysphoria, the medical diagnosis for the clinically significant distress sometimes resulting from the incongruence between a person’s gender identity and their sex assigned at birth. Left untreated, this serious medical condition often leads to debilitating distress, depression, anxiety, impairment of function, and self-harm, including suicide.