In a landmark ruling, a West Virginia court rules that gender confirmation surgeries must be paid for by taxpayers

Gender confirmation surgeries must be paid for by state health care plans, a Richmond court has ruled.

The federal appeals court is the first in the nation to say transition should be covered for transgender people with government-sponsored insurance.

The decision stemmed from a series of cases in North Carolina and West Virginia in which transgender residents argued that their surgeries should be funded by employee health plans or state-subsidized Medicaid.

State officials said their policy of not covering transgender surgeries was based on financial concerns and not bias.

But the Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in the case Monday.

The court’s ruling does not mean that tTransfer will be automatically reimbursed transgender people with government-sponsored insurance. The pronounciation An appeal could be made to the Supreme Court, which recently allowed Idaho to enforce a ban on gender-affirming care for minors.

But the powerful Court has been somewhat reluctant to take up the issue and has allowed several 4th Circuit rulings in support of transgender rights.

In West Virginia, transgender Medicaid recipients challenged the state’s policy, which since 2004 has banned funding for “transsexual surgeries.”

In North Carolina, state workers challenged their coverage, which has not included gender dysphoria surgeries since 2018.

In January, Ohio became the 23rd state to ban transgender care for minors, amid a wave of bills passed by Republicans in recent years.

“The exclusions from coverage discriminate on the basis of sex and gender identity, and are not substantially related to a significant government interest,” wrote Judge Roger Gregory, first appointed by former President Bill Clinton and reappointed by former President George W. Bush. in the opinion of the majority.

In January, Ohio became the 23rd state to ban gender-affirming care for minors. The new restrictions put doctors who continue to provide care to minors at risk of losing their medical licenses

The ruling follows a decision earlier this month by 4th Circuit judges that West Virginia’s ban on transgender girls playing sports as girls, and vice versa, is illegal because of a federal civil rights law that bans sex discrimination in schools.

As with the ruling on the transgender sports law, West Virginia Attorney General Patrick Morrisey said his office planned to appeal Wednesday’s decision in the health care case.

“Decisions like this, from a court dominated by Obama and Biden appointees, cannot stand: we will take this to the Supreme Court and win,” Morrisey said in a statement.

After the ruling, West Virginia plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, said, “I am so relieved that this court ruling brings us one step closer to the day when Medicaid no longer covers transgender West Virginians.” can deny access to the essential health care that our doctors say is necessary for us.”

A spokesperson for North Carolina State Treasurer Dale Folwell, whose department oversees the state’s health plan, said the agency was still reviewing the decision Monday but would provide a response later.

During oral arguments in September, at least two judges said the case will likely eventually end up before the U.S. Supreme Court.

Both states appealed separate lower court rulings that found that denying gender-affirming care was discriminatory and unconstitutional.

Two panels of three judges from the Fourth Circuit heard arguments in both cases last year before deciding to intertwine the two cases and have them heard before the full court.

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

The judge had ruled in favor of the employees and their family members, who said in a 2019 lawsuit that they were denied coverage for gender-affirming care under the plan.

North Carolina’s State Insurance Plan provides medical coverage for more than 750,000 teachers, state employees, retirees, legislators and their dependents. While it offers advice for gender dysphoria and other diagnosed mental health conditions, it does not cover treatment ‘related to gender changes or reassignment and associated care’.

In August 2022, a federal judge ruled that West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents.

An original lawsuit filed in 2020 also named state employee health plans. A settlement with The Health Plan of West Virginia Inc. in 2022 led to the lifting of the exclusion of gender-affirming care in that company’s Public Employees Insurance Agency plans.

During oral arguments in September, attorneys for the state of North Carolina said the state-sponsored plan is not required to cover gender-affirming hormone therapy or surgery because being transgender is not a disease.

They claimed that only a subset of transgender people suffer from gender dysphoria, a diagnosis of anxiety about gender identity that does not match a person’s assigned sex.

Before offering pharmaceutical or surgical interventions, medical guidelines require thorough psychological assessments to confirm gender dysphoria before initiating treatment.

West Virginia attorneys said the U.S. Centers for Medicare & Medicaid Services has declined to issue a nationwide coverage decision on gender confirmation surgery.

State attorneys said West Virginia’s policy is also not a case of discrimination, but of a state trying to make the best use of limited resources. West Virginia has a $128 million Medicaid deficit for the coming year, which is expected to increase to $256 million by 2025.

Unlike North Carolina, the state has covered hormone therapy and other pharmaceutical treatments for transgender people since 2017.