Federal Appeals Court Rules Against West Virginia and North Carolina in Transgender Health Care

On Monday, April 29, the Richmond-based 4th U.S. Circuit Court of Appeals has made a significant ruling against the discriminatory health care coverage exclusions for transgender individuals in the states of West Virginia and North Carolina. The court ruled 8-6 in favor of the case, which is likely to be taken up by the U.S. Supreme Court.

The case involved the coverage of gender-affirming care in North Carolina’s state employee health plan and the coverage of gender-affirming surgery in West Virginia Medicaid. The court found that both states' policies constituted a form of discrimination based on sex and gender identity and were not substantially related to an important government interest.

Landmark Decision

This landmark decision follows a series of similar cases being considered in courts across the country. It is the first U.S. Court of Appeals decision to address government-sponsored coverage exclusions of gender-affirming medical care and to determine the lawfulness of these exclusions.

Responding to the decision, West Virginia Attorney General Patrick Morrisey expressed his intention to appeal the ruling to the Supreme Court and expressed confidence in prevailing in the appeal. Similarly, North Carolina State Treasurer Dale Folwell stated that the majority decision was in direct conflict with other federal appeals court decisions and expressed hope for a correction by the U.S. Supreme Court. Folwell also highlighted the financial challenges faced by the State Health Plan, emphasizing the need to make reasoned and responsible decisions to prevent the plan from potential collapse due to undue financial burdens.

Both West Virginia and North Carolina had separately appealed lower court rulings that found the denial of gender-affirming care to be discriminatory and unconstitutional. The Fourth Circuit judges had decided to combine the two cases and present them before the full court, leading to this crucial ruling.

Preceding Litigation

In June 2022, a North Carolina trial court had ordered the state plan to provide medically necessary services, including hormone therapy and certain surgeries, for transgender employees and their dependents. Similarly, in August 2022, a federal judge ruled that West Virginia’s Medicaid program must cover gender-affirming care for transgender residents.

It is worth noting that West Virginia has been covering hormone therapy and pharmaceutical treatments for transgender individuals since 2017, and the program also includes coverage for certain surgeries unrelated to gender dysphoria, such as those related to cancer diagnoses.

Following the ruling, plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, expressed relief, calling the state's refusal to cover her care deeply dehumanizing. She emphasized the importance of Medicaid not denying transgender individuals access to essential healthcare deemed necessary by medical professionals.

It is expected that this decision will have a significant impact on the ongoing legal battles concerning health care coverage for transgender individuals and may shape future policies and regulations in this domain.