RICHMOND, Virginia – A federal appeals court has ruled West Virginia and North Carolina’s refusal to cover some health care for transgender people with government-sponsored insurance is discriminatory.
West Virginia’s attorney general says he plans to take the case to the U.S. Supreme Court.
In an April 29, ruling, the U.S. Fourth Circuit Court of Appeals issued an 8-6 decision in favor of Shauntae Anderson, a transgender woman covered by West Virginia Medicaid who is seeking gender-affirming surgery. The ruling also applies to North Carolina’s state employee health plan not covering gender-affirming care.
West Virginia Attorney General Patrick Morrisey said his office will fight the decision.
“Decisions like this one, from a court dominated by Obama- and Biden-appointees, cannot stand: we’ll take this up to the Supreme Court and win,” Morrisey said. “We are confident in the merits of our case: that this is a flawed decision and states have wide discretion to determine what procedures their programs can cover based on cost and other concerns.
“Just one single sex-transition surgery can cost tens of thousands of dollars. Taxpayers should not be required to pay for these surgeries under Medicaid. Our state should have the ability to determine how to spend our resources to care for the vital medical needs of our citizens.”
Judge Roger Gregory wrote the majority opinion.
“The coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,” wrote Gregory, who first appointed by President Bill Clinton and re-appointed by President George W. Bush.
In a statement, Anderson called the state’s refusal to cover her care “deeply dehumanizing.”
“I am so relieved that this court ruling puts us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential healthcare that our doctors say is necessary for us,” she said in a statement.
Before the 4th Circuit heard the case las fall, both West Virginia and North Carolina had appealed lower court rulings saying the states’ denials of care were discriminatory and unconstitutional. Two three-judge panels heard arguments in the separate case before deciding to combine them for the full court to decide.
In 2022, U.S. District Judge Chuck Chambers ruled West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents. When the federal lawsuit first was filed in 2020, a transgender state employee also was named as a plaintiff. But a settlement with The Health Plan of West Virginia in 2022 removed her from the case.
The state Department of Health and Human Resources and former secretary Bill Crouch were listed as defendants in the original complaint.
West Virginia has covered hormone therapy and other pharmaceutical treatments for transgender people since 2017.
In the North Carolina case, a court in 2022 demanded the state pay for “medically necessary services” such as hormone therapy and some surgeries. The state provides counseling for gender dysphoria, but it doesn’t cover treatment related to sex changes or modifications and related care.
