ANCHORAGE, Alaska (AP) — A lawsuit has challenged the legality of a rule in Alaska’s Medicaid program excluding transgender residents from coverage for transition-related health care.

The lawsuit arguing the exclusion is a civil rights violation names as defendants the Alaska Department of Health and Social Services and department Commissioner Adam Crum, The Anchorage Daily News reported Wednesday.

Alaska is one of 10 states with a Medicaid program explicitly excluding the transition-related coverage.

The lawsuit describes plaintiffs Swan Being, Robin Black and Austin Reed seeking care and being told Alaska Medicaid would not cover their treatment.

The lawsuit is an amended version of an action filed last year.

“Not only do the (state) regulations discriminate on the basis of sex, they also lack any rational basis,” the lawsuit says. “The regulations fly in the face of the medical consensus that gender-confirming medical care is the only safe and effective treatment for gender dysphoria.”

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The Diagnostic and Statistical Manual of Mental Disorders describes gender dysphoria as clinically significant distress or impairment “associated with the incongruence between a transgender person’s gender identity and assigned sex.”

The plaintiffs and the state have entered discussions and hope to reach a settlement.

Crum proposed a change to state Medicaid regulations in February to allow “non-surgical services related to gender reassignment.”

Attorneys for the plaintiffs said the rule change would be insufficient because the proposal continues to exclude surgical gender-confirming care from coverage.

Carl Charles, an attorney with Lambda Legal who is representing the plaintiffs, said there will likely be a decision in the spring if no settlement is reached within the next two months.

The Alaska Department of Law said in an email that the state was in settlement negotiations and had no comment.