Federal Appeals Court Rules West Virginia and North Carolina’s Refusal to Cover Transgender Health Care Discriminatory

The federal appeals court has ruled that West Virginia and North Carolina’s refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory. The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in a case involving coverage of gender-affirming care by North Carolina’s state employee health plan and the coverage of gender-affirming surgery by West Virginia Medicaid.

Judge Roger Gregory, in the majority opinion, stated that the coverage exclusions are discriminatory based on sex and gender identity and are not substantially related to an important government interest. This decision is likely to be appealed to the U.S. Supreme Court.

The ruling follows a recent decision by the 4th Circuit judges that West Virginia’s transgender sports ban violates the rights of a teen athlete under Title IX. West Virginia Attorney General Patrick Morrisey has stated that his office plans to appeal the decision.

After the ruling, West Virginia plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, called the state’s refusal to cover her care “deeply dehumanizing.” She expressed relief that the court ruling puts transgender West Virginians one step closer to accessing essential healthcare.

Both states appealed separate lower court rulings that found the denial of gender-affirming care to be discriminatory and unconstitutional. The cases were presented before the full court after two panels of three Fourth Circuit judges heard arguments.

In North Carolina, a trial court ruled in June 2022 that the state plan must pay for medically necessary services, including hormone therapy and some surgeries, for transgender employees and their children. The North Carolina state insurance plan currently does not cover treatment related to sex changes or modifications.

In West Virginia, a federal judge ruled in August 2022 that the state’s Medicaid program must provide coverage for gender-affirming care for transgender residents. The state had previously settled with a health insurance company to remove the exclusion on gender-affirming care in state employee health plans.

Attorneys for the states argued that being transgender is not an illness and that only a subset of transgender people suffer from gender dysphoria. They also cited limited resources as a reason for the coverage exclusions. West Virginia has a projected deficit in Medicaid, while North Carolina’s state plan does not cover gender-affirming hormone therapy or surgery.

The decision is likely to have far-reaching implications for transgender healthcare access and could set a precedent for future cases involving discrimination based on gender identity.