CHARLESTON, W.Va. — West Virginia and North Carolina’s refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory, a federal appeals court ruled Monday in a case likely to go to the U.S. Supreme Court.
The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in the case involving coverage of gender-affirming care by North Carolina’s state employee health plan and coverage of gender-affirming surgeries by West Virginia Medicaid.
“The exclusions from coverage discriminate on a prima facie basis on the basis of sex and gender identity, and are not substantially related to a significant government interest,” Judge Roger Gregory, appointed by former U.S. President George W. Bush, wrote in the majority opinion.
The ruling follows a decision earlier this month by 4th Circuit judges that West Virginia’s transgender sports ban violates a teen athlete’s rights under Title IX, the 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, called her state’s refusal to cover her care “grossly inhumane.”
“I am so relieved that this court ruling brings us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential health care our doctors say is necessary for us,” Anderson said in a statement. a statement.
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. The plan covers more than 750,000 teachers, state employees and teachers, retirees and dependents.
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 include 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.