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The bans for state employees and Medicaid recipients, respectively, are unconstitutional, the Fourth Circuit ruled.
North Carolina’s and West Virginia’s bans on coverage for gender-affirming care for certain populations are discriminatory and unconstitutional, a federal appeals court ruled Monday in the first appellate decision to mandate coverage by a state health plan.
The U.S. Court of Appeals for the Fourth Circuit upheld lower court rulings in two separate lawsuits. North Carolina denied coverage for transgender people and dependents enrolled in the state employees’ insurance plan, while West Virginia denied it for trans Medicaid beneficiaries. The treatments were covered for, say, cisgender people with genital anomalies or other conditions, but not for trans people with gender dysphoria. West Virginia has recently updated its plan to cover hormone treatment and psychiatric services to trans people but still denied coverage for surgery.
Trans North Carolina residents filed suit in 2019, with representation by Lambda Legal, the Transgender Legal Defense and Education Fund, and the law firms of HWG LLP and McDermott, Will and Emery LLP. The West Virginia suit was filed in 2020 by Lambda Legal, Nichols Kaster, and the Employment Law Center on behalf of Medicaid recipients. U.S. district courts ruled in the plaintiffs’ favor in 2022 in both suits.
“The North Carolina State Health Plan and the West Virginia Medicaid Program discriminate on the basis of gender identity and sex in violation of the Equal Protection Clause” of the U.S. Constitution, Judge Roger Gregory of the Fourth Circuit wrote for the court majority. “The West Virginia Medicaid Program violates the Medicaid Act’s availability and comparability provisions and violates the Affordable Care Act’s anti-discrimination provision.”
“West Virginia’s denial of medically necessary care just because of who I am was deeply dehumanizing,” plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, said in a Lambda Legal press release. “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 health care that our doctors say is necessary for us.”
“I am pleased with this powerful court victory not only for myself but for all other state employees who have been discriminated against across North Carolina,” added Julia McKeown, an associate professor at the College of Education at North Carolina State University and plaintiff in the North Carolina suit. “As government employees, all we want is equal access to health care, but we were denied just because we are transgender. I’m relieved the court found this discrimination unlawful, and hope North Carolina officials will finally stop their wasteful fight to deny us our rights and will now stand on the side of equality.”.
“We are pleased with the Court’s decision, which will save lives,” said Lambda Legal Senior Counsel Tara Borelli, the lead lawyer on both lawsuits. “It confirms that discriminating against transgender people by denying critical medical care is not only wrong but unconstitutional. No one should be denied essential health care, but our clients in both cases were denied coverage for medically necessary care prescribed by their doctors just because they’re transgender.”
“This ruling sets a clear precedent not just for North Carolina and West Virginia but to all jurisdictions within the Fourth Circuit, including South Carolina, where legislators are considering a discriminatory health care ban,” Lambda Legal’s press release notes.
The decision is “a major win for transgender rights amid a nationwide wave of anti-trans activism and legislation,” The Washington Postadds. The states have the option of appealing to the U.S. Supreme Court.
