Two transgender patients are suing Wisconsin’s health services department for refusing to pay for procedures related to gender transition.

Doctors for Cody Flack and Sara Ann Makenzie say they need surgery to treat gender dysphoria, a condition in which people identify with a gender that is different than the one they were given at birth. Flack and Makenzie have Medicaid, a program paid for by the state and federal government, but the program will not pay for their surgeries because they are deemed by the state to be “medically unnecessary.” Without the coverage, Flack and Makenzie cannot afford the procedures.