West Virginia’s and North Carolina’s Transgender Care Coverage Policies Ruled Discriminatory
A federal appeals court has recently ruled that the refusal of West Virginia and North Carolina to cover certain health care services for transgender individuals with government-sponsored insurance is discriminatory. The Richmond-based 4th U.S. Circuit Court of Appeals made an 8-6 decision in a case involving the coverage of gender-affirming care by North Carolina’s state employee health plan and the coverage of gender-affirming surgery by West Virginia Medicaid.
Background and Policies
In North Carolina, the policy explicitly prohibits treatment or studies “leading to or in connection with sex changes or modifications and related care.” On the other hand, West Virginia’s policy bars coverage of “transsexual surgery.” These exclusions of gender-affirming medical care have been subject to legal challenges across the country, with similar cases currently under consideration in various courts.
This recent ruling by the 4th U.S. Circuit Court of Appeals is the first decision by a federal appeals court to address the legality of government-sponsored coverage exclusions of gender-affirming medical care.
The Implications of the Ruling
The court’s ruling follows a previous decision by 4th Circuit judges that West Virginia’s transgender sports ban violates the rights of a teen athlete under Title IX, the federal civil rights law that prohibits sex-based discrimination in schools. West Virginia Attorney General Patrick Morrisey has announced plans to appeal this decision, similar to his response to the transgender sports law ruling.
North Carolina State Treasurer Dale Folwell, whose department oversees the state’s health plan, expressed disagreement with the majority decision in a news release. He stated that the decision conflicts with rulings from other federal appeals courts and expressed hope that it would be corrected by the U.S. Supreme Court. Folwell also highlighted the financial challenges faced by the state health plan as its members age and experience declining health.
In their majority opinion, the judges emphasized that the cost of treatment is not a sufficient argument to support upholding a policy that is deemed discriminatory. Both West Virginia and North Carolina had appealed separate lower court rulings that found the denial of gender-affirming care to be discriminatory and unconstitutional.
It is worth noting that in June 2022, a North Carolina trial court ordered the state plan to cover “medically necessary services,” including hormone therapy and certain surgeries, for transgender employees and their children. The ruling came after a lawsuit filed in 2019 by employees and their dependents who were denied coverage for gender-affirming care under the plan. The North Carolina state insurance plan provides medical coverage for over 750,000 teachers, state employees, retirees, lawmakers, and their dependents.
Given the significance of this ruling and the conflicting decisions from various courts, it is likely that this case will be appealed to the U.S. Supreme Court for a final resolution.
