Justice. Gender Transitions: Health Insurance Condemned Several Times for Unreimbursed Care

Convictions against health insurance are increasing. Across France, several legal actions have been filed against primary health insurance funds (CPAM) by transgender people for refusing to cover care related to their transition.

Last month, the Seine-Saint-Denis CPAM was ordered to pay €3,000 in damages to two trans men and to reimburse the cost of one of their mastectomies (breast removal), which cost more than €5,300. In May, the Bas-Rhin CPAM was also ordered to reimburse the cost of a trans man's mastectomy in Strasbourg and pay him €3,000 in damages.

"For once, everything worked out well," Arsène rejoices. The 29-year-old, living in Aubervilliers, is pleased that the discrimination he suffered has been recognized by the courts. "Will this be a deterrent and help prevent further situations of discrimination against trans people by health insurance?" he nevertheless wonders. "Despite the various court decisions, the CPAM (Health Insurance Fund) has not changed its policy so far," laments Laura Gandonou, lawyer for Arsène and the other applicant from Seine-Saint-Denis. But the lawyer is not giving up. Gandonou is representing seven other trans people who have also taken various CPAMs to court, in Lyon, Grenoble, Cahors (Lot), and Toulouse.

In the Rhône region, three trans men are also seeking reimbursement for their mastectomies, and another trans person is contesting her denial of long-term care benefits on the grounds that she was a minor at the time of the application. In these four cases, Mr. Gandonou goes further, demanding that "the judge order the Health Insurance Agency to raise awareness among its employees about transgender issues." In Lyon and Toulouse, hearings are expected to take place in early 2026.

In Grenoble, a transgender woman is suing the Isère CPAM (Health Insurance Fund) for refusing to cover her mammoplasty costs. "This is the most serious case. Due to lack of coverage, my client self-medicated, which caused her heart problems. Furthermore, she didn't leave her home for months because she no longer accepted her body," explains Mr. Gandonou. The hearing is scheduled for December 4, 2025.

Social Security is required to reimburse 100% of care initiated as part of a transition process—except for excess fees. However, in reality, many obstacles stand in the way of some transgender individuals, and each CPAM (Health Insurance Fund) will not reimburse a particular procedure in the same way. To justify their refusal to cover costs, many CPAMs rely on a protocol dating back to 1989, which is now obsolete. For Mr. Gandonou, "the law does not need to be changed, but simply applied."

In a framework decision dated June 16, 2025, the Defender of Rights recommends that the National Health Insurance Fund (CNAM) train all CPAM staff in order to guarantee uniform and non-discriminatory financial support for transition pathways throughout the country.

Contacted, the Cnam indicates that "training for health insurance staff, co-developed with Vers Paris sans Sida, OUTrans, the CPAM of Seine-Saint-Denis and the Cnam, as well as the support of Santé publique France, has already been underway since last summer. This training covers in particular the technical aspects related to transition pathways." The organization also specifies that "a group of experts specialized in the processing of files and in direct support of the insured persons concerned is working with the representatives of the regional directorates of the Medical Service and the representatives in CPAM to streamline the management of files and the coverage of procedures related to the transition."