Federal Court: Rules State Health Plans Must Pay for Trans Care

On Monday, the Virginia federal appeals court ruled state healthcare plans must pay for transgender care.

The running stems from battles over North Carolina and West Virginia’s refusal to cover specific healthcare for transgender individuals with government-sponsored insurance. 

The 4th U.S. Circuit Court of Appeals, which is based in Richmond, ruled 8-6 that the states’ plans are discriminatory.

Patrick Morrisey, West Virginia Attorney General, immediately released a statement announcing his office’s intention to appeal.

“Decisions like this one, from a court dominated by Obama- and Biden-appointees, cannot stand: we’ll take this up to the Supreme Court and win,” said Morrisey.

Following the ruling, Shauntae Anderson, a West Virginia plaintiff, a West Virginia Medicaid participant, and a Black transgender woman, called the refusal by her state to cover her care “deeply dehumanizing.”

“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 healthcare that our doctors say is necessary for us,” said Anderson in a statement.

During the September oral arguments, at least two judges said that it was likely that the case would eventually reach the United States Supreme Court.

Both states appealed separate rulings by the lower court that found the denial of gender care to be unconstitutional and discriminatory. Two panels of three judges on the Fourth Circuit herded arguments in both cases last year before deciding to intertwine them and present them in front of the full court of 15.

Judge has previously ruled in favor of employees and their dependents

In June of 2022, a trial court in North Carolina demanded the state plan pay for “medically necessary services,” including some surgeries and hormone therapy, for transgender employees and their children. 

The judge ruled in favor of the employees and their dependents, who claimed in a 2019 lawsuit they were denied healthcare coverage that is gender-related under the plan.

The state insurance plan in North Carolina provides medical coverage for over 750,000 state employees, teachers, legislators, retirees, and their dependents. Although it allows for counseling for gender dysphoria along with other mental health conditions that are diagnosed, it doesn’t cover treatment “in connection with sex changes or modifications and related care.”

A federal judge ruled West Virginia’s Medicaid Program must provide coverage for transgender residents’ care in August 2022.

The 2020 original lawsuit additionally named state employee health plans. A 2022 settlement with The Health Plan of West Virginia Inc. removed the gender-related healthcare exclusion from the company’s Public Employees Insurance Agency plans.