(CHARLESTON, W.Va.) — West Virginia and North Carolina’s refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory, a federal appeals court ruled Monday in a case that will likely be addressed to the Supreme Court of the United States.
The Richmond-based U.S. Court of Appeals for the Fourth Circuit ruled 8-6 in the case involving coverage of gender-affirming care by North Carolina’s state employee health plan and coverage of gender affirmation surgery by West Virginia Medicaid.
“The coverage exclusions clearly discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,” said Judge Roger Gregory, first appointed by former President Bill Clinton and reappointed by former President George W. Bush. he wrote in the majority opinion.
The ruling follows a decision earlier this month by Fourth Circuit judges that West Virginia’s ban on transgender sports violates a teen athlete’s rights under Title IX. federal civil rights law which prohibits discrimination based on sex in schools.
As with the ruling on the transgender sports law, West Virginia Attorney General Patrick Morrisey said his office planned to appeal Monday’s decision on the health care case.
“Decisions like this, from a court dominated by Obama and Biden appointees, cannot stand: we will take this to the Supreme Court and win,” Morrisey said in a statement.
After the ruling, West Virginia plaintiff Shauntae Anderson, a Black transgender woman and Medicaid participant from West Virginia, called her state’s refusal to cover her care “deeply dehumanizing.”
“I am so relieved that this court ruling brings us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential health care our doctors say is necessary for us,” he said. Anderson in a statement.
A spokesman for North Carolina State Treasurer Dale Folwell, whose department oversees the state’s health plan, said the agency was still reviewing the decision Monday but would have a response later.
During oral arguments in September, at least two justices said the case is likely to eventually reach the U.S. Supreme Court. Both states appealed separate lower court rulings that found the denial of gender-affirming care was discriminatory and unconstitutional. Two three-judge panels of the Fourth Circuit heard arguments in both cases. last year before deciding to intertwine the two cases and see them presented to the full court.
In June 2022, a North Carolina Trial Court It demanded that the state plan pay for “medically necessary services,” including hormone therapy and some surgeries, for transgender employees and their children. The judge ruled in favor of the employees and their dependents, who said in a 2019 lawsuit that they were denied coverage for gender-affirming care under the plan.
North Carolina’s state insurance plan provides health coverage to more than 750,000 teachers, state employees, retirees, legislators and their dependents. While it provides counseling for gender dysphoria and other diagnosed mental health conditions, it does not cover treatment “in relation to sex changes or modifications and related care.”
In August 2022, a federal judge ruled that West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents.
In original claim introduced in 2020 also names health plans for state employees. An agreement with The Health Plan of West Virginia Inc. in 2022 led to the elimination of the gender-affirming care exclusion in that company’s Public Employees Insurance Agency plans.
During oral arguments in September, attorneys for the state of North Carolina said the state-sponsored plan is not required to cover hormone therapy or gender-affirming surgery because being transgender is not a disease. They stated that only a subset of transgender people suffer from gender dysphoria, a diagnosis of distress over gender identity that does not match a person’s assigned sex.
Before offering a pharmaceutical or surgical intervention, Medical guidelines require extensive psychological evaluations. to confirm gender dysphoria before starting any treatment.
West Virginia attorneys said the U.S. Centers for Medicare and Medicaid Services has declined to issue a national coverage decision on gender-affirming surgery.
State attorneys said West Virginia’s policy is also not a case of discrimination, but rather a state trying to make better use of limited resources. West Virginia has a $128 million shortfall in Medicaid next year, which is projected to widen to $256 million in 2025.
Unlike North Carolina, the state has covered hormone therapy and other pharmaceutical treatments for transgender people since 2017.