The ACLU of Kansas and the Transgender Legal Defense and Education Fund sent a letter to Blue Cross Blue Shield of Kansas ("BCBSKS") notifying the company of its unconstitutional barriers to patients in need of transgender-related healthcare. Currently, the BCBSKS Policy contains criteria for approval of such care that fails to draw on standards rooted in clinical practice or current standards as well as blanket exclusions for medically necessary care, which conflict with non-discrimination provisions of Section 1557 of the Patient Protection and Affordable Care Act and K.S.A 40-2404(7). 

The letter recommends removing the requirements of changes to legal documents, two qualified medical referrals for a mastectomy and an age of 18 years. Additionally, the letter recommends removing binary requirements that exclude nonbinary individuals.