The American Civil Liberties Union of Kentucky filed a class-action lawsuit Monday on behalf of a transgender woman in state custody, arguing that transgender inmates should have access to hormone replacement therapy.

According to a press release from the ACLU, the lead plaintiff, Maddilyn Marcum, first received a diagnosis of gender dysphoria in 2009 and received hormone replacement therapy under a licensed medical provider’s care for five years prior to her incarceration at Northpoint Training Center in Boyle County. Once incarcerated, corrections officials initially denied the continuation of hormone replacement therapy, but eventually deemed the treatment necessary for her.

Senate Bill 2 changed everything for Marcum. After years of receiving treatment for her gender dysphoria, she is now being denied medical care after the department of corrections began enforcing the new state law in late June.

During the 2025 Kentucky General Assembly, lawmakers passed SB 2, which prohibits the use of public funds to cover gender-affirming care—including hormone replacement therapy and gender reassignment surgeries for incarcerated trans people.

Gov. Andy Beshear opted not to veto the bill, but allowed the bill to pass without his signature. A statement from his office said, “The Governor does not believe that the state should pay for gender reassignment surgeries for convicted felons, as this would mean those in prison would receive better access to medical care than a law-abiding citizen.”

The ACLU’s 19-page filing argues that banning the use of public funds for hormone replacement therapy is unconstitutional, claiming it violates the 8th Amendment’s prohibition of cruel and unusual punishment and the 14th Amendment’s guarantee of equal protection. The ACLU is only arguing against the ban on gender-affirming medication, not the part of the law that prohibits the department of corrections from using funds for gender reassignment surgeries.

“People who are incarcerated are already serving the sentence they received,” said William Sharp, senior staff attorney for the ACLU of Kentucky. “But that sentence does not include, nor does the Constitution permit, that they also be denied adequate healthcare simply because politicians disagree with the treatment that the medical community recognizes as appropriate and that medical providers have prescribed.”

Marcum brings the suit on behalf of herself and the current and future incarcerated individuals in the department of correction’s custody who will be deprived of hormone replacement therapy. At the time Senate Bill 2 passed, 67 of roughly 20,000 inmates about 0.35% of Kentucky’s incarcerated population—were receiving treatment for gender dysphoria. Now, all have lost or will lose access to care.

“Untreated Gender Dysphoria creates a substantial risk of severe physical and psychological harm to the individual, which I have personally suffered from in my life,” said Marcum in a press release from the ACLU. “This case is not about a lifestyle choice, it is about ensuring that I and others receive medically accepted, appropriate healthcare for a diagnosed condition.”

In addition to suing Kentucky Department of Corrections officials, the ACLU also filed suit against Appalachian Regional Healthcare, Inc., challenging their corporate policy that mandates providers, including the providers overseeing Marcum’s care, enforce the new law by reducing, terminating, or withholding hormone replacement therapy even when treatment is considered medically necessary.  

Chris Hartman, executive director of the Fairness Campaign, said enforcement of SB 2 amounts to cruel and unusual punishment and a violation of rights.

“You’ve got to give people incarcerated in your state access to the healthcare that the doctors say that they need,” he told Queer Kentucky. “There’s no exception there. That includes transgender inmates.”

Courts across the country have consistently ruled that laws like Senate Bill 2 are unconstitutional when applied to incarcerated people. In the 2011 case Fields v. Smith, the U.S. Seventh Circuit Court of Appeals struck down a Wisconsin law that barred access to gender-affirming hormones for people in the custody of the Department of Corrections, finding it violated the Eighth Amendment’s ban on cruel and unusual punishment.

“I think the court will issue an injunction and it will be fairly swift,” Hartman said. “The provisions of Senate Bill 2 will be invalidated and Senate Bill 2 will become a meaningless law.”