NEW YORK -- Should New York City government pay for a teenager to have a sex change operation?

Family Court said yes, but a higher court on appeal Tuesday said no.

This is the hard-fought case of Mariah, a child born biologically as a boy but later diagnosed with gender identity disorder.

Mariah was in foster care with the Administration for Children's Services, as are many transgender teens. When ACS refused to pay for Mariah's operation, the teenager sued.

Several experts and psychologists testified that the operation was "medically necessary" to prevent serious depression.

ACS refused on the grounds that Medicaid law does not support funding of such a procedure.

Family Court ordered ACS to provide the surgery and ACS appealed.

During the appeal process, ACS was asked to elaborate on the reasons for denying the procedure. City officials argued that Mariah, a minor, was not ready for this life-altering procedure and did not fully comprehend the costs or complications.

Tuesday the Appellate Division ruled that family court does not have the jurisdiction to order ACS to provide foster children with medical and surgical care that ACS has determined to be unnecessary.

"We are pleased" by the decision, said city attorney Julian Kalkstein. "As the court's opinion reflects, ACS took a careful look at this child's circumstances before deciding that sex reassignment surgery was not appropriate."

The Legal Aid Society, which represented Mariah, has not responded to requests for a comment on the ruling by WNBC.com.

This case reflects how complicated the issues can be when dealing with minors in foster care, decisions that would ordinarily be made in consultation with parents are made by government.

Some insiders for years have complained about the distraction this case caused to the agency's main mission, to protect children. There was heated debate inside ACS about what the right decision was.

Sources told News 4 New York Mariah is now an adult.