The 4th U.S. Circuit Court of Appeals recently handed down a ruling that could have significant implications for transgender individuals seeking healthcare coverage in West Virginia and North Carolina. The court ruled that the states’ refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory.
Specifically, the ruling involves the coverage of gender-affirming care by North Carolina’s state employee health plan and the coverage of gender-affirming surgery by West Virginia Medicaid. The court found that these coverage exclusions discriminate on the basis of sex and gender identity and are not substantially related to an important government interest.
This decision marks the first U.S. Court of Appeals ruling to consider government-sponsored coverage exclusions of gender-affirming medical care. However, it is expected to be appealed to the U.S. Supreme Court.
West Virginia Attorney General Patrick Morrisey plans to appeal the decision, arguing that decisions from courts dominated by Obama- and Biden-appointees cannot stand. North Carolina State Treasurer Dale Folwell also hopes the U.S. Supreme Court will correct the ruling, as it conflicts with decisions from other federal appeals courts.
Both states had appealed separate lower court rulings that found the denial of gender-affirming care to be discriminatory and unconstitutional. A North Carolina trial court had previously ordered the state plan to pay for “medically necessary services” for transgender employees and their children, while a federal judge ruled that West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents.
The states had argued that only a subset of transgender people suffer from gender dysphoria, a diagnosis of distress over gender identity. However, the court found that gender dysphoria is intimately related to transgender status and that coverage exclusions for it bar treatments on the basis of transgender identity.
Despite West Virginia covering hormone therapy and other pharmaceutical treatments for transgender people since 2017, the state had previously excluded coverage for gender-affirming surgery. Plaintiff Shauntae Anderson, a Black transgender woman in West Virginia Medicaid, described the state’s refusal to cover her care as deeply dehumanizing and expressed relief at the court ruling.
“Social media scholar. Reader. Zombieaholic. Hardcore music maven. Web fanatic. Coffee practitioner. Explorer.”