A federal appeals court ruled Monday that state healthcare plans are required to cover sex change procedures in West Virginia and North Carolina, calling the denial of coverage “discriminatory.”
The Fourth Circuit Appeals Court in Richmond, Virginia sided with lower courts, which held that the state health insurance plans that deny coverage for transgender patients violate their equal protection under the Fourteenth Amendment.
The court issued its decision regarding two cases; one lawsuit was filed by West Virginians on Medicaid who identify as transgender and could only receive coverage for certain “gender-affirming” treatments. The other lawsuit was brought by state employees in North Carolina and their dependents who identify as transgender and have been prevented from undergoing any medical sex-change procedures or treatments.
According to NPR, both states’ health insurance plans have had to cover transgender-related services since lower courts ruled in favor of the plaintiffs in 2022.
Judge Roger Gregory, who authored the majority opinion, used West Virginia’s Medicaid Program as an example. The program, “covers some gender-affirming care, but not gender-affirming surgery, or as the Program calls it ‘[t]ranssexual surgery,'” he wrote. “The program does, however, cover the same surgical procedures when conducted to treat non-gender dysphoria diagnoses.”
“For example,” Judge Gregory writes, “the Program covers mastectomies to treat cancer, but not to treat gender dysphoria.” The court held that the West Virginia program exclusions violates the Medicaid Act and the Affordable Care Act.
North Carolina State Treasurer Dale Folwell issued a statement following the court’s decision, claiming that the ruling is in direct conflict with multiple decisions from other federal appeals courts and, hopefully, will be corrected by the U.S. Supreme Court.”
Dissenting judges of the court, of whom there were six in opposition to the majority decision, wrote that by using “the Constitution to establish a nationwide mandate that States pay for emerging gender dysphoria treatments,” the court imposed itself on the “State’s prerogative under its basic police power to safeguard the health and welfare of its citizens.”
