CHARLESTON, W.Va. (AP) – A federal appeals court says West Virginia and North Carolina’s denial of certain government-sponsored health insurance coverage to transgender people is discriminatory. ruled Monday in a case that will likely go to the U.S. Supreme Court.
The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in a case over coverage of gender reassignment care by North Carolina’s State Employees Health Plan and coverage of gender reassignment surgery by Medicaid in West Virginia.
Specifically, North Carolina’s policy prohibits treatment, research, and related care that “leads to or is related to sex reassignment or reassignment,” and West Virginia prohibits “sex reassignment surgery.” are doing.
Judge Roger Gregory, who was first appointed by former President Bill Clinton and reappointed by former President George W. are not substantially related.” wrote the majority opinion.
Although similar cases are being heard in courts across the country, Monday’s decision is the first by a U.S. appeals court to consider exemptions from government-sponsored gender-affirming health care and whether those exemptions are legal.
The ruling follows a 4th Circuit judge’s ruling earlier this month that West Virginia’s transgender sports ban violates the rights of teenage athletes under Title IX. federal civil rights law It prohibits discrimination based on gender in schools.
Similar to the Transgender Sports Act ruling, West Virginia Attorney General Patrick Morrissey said his office plans to appeal Monday’s ruling in the medical case.
“A decision like this from a court dominated by Obama-Biden appointees is unacceptable. We will take this to the Supreme Court and win,” Morrissey said in a statement.
North Carolina State Treasurer Dale Falwell, who oversees North Carolina’s health care plan, said in a news release that Monday’s majority decision is “directly inconsistent” with other federal appeals court decisions and has been amended by the U.S. Supreme Court. He said he hopes it will be done.
Falwell said state health plans are threatened with financial stress as their members age and become less healthy.
“So we can’t say this plan is everything to everyone,” Falwell said. “Unfettered by the reality of the plan’s financial situation, the majority opinion opens the door for disgruntled individuals to override the plan’s rational and responsible decisions and lead to its collapse.”
In the majority opinion, the justices said that the cost of treatment was not a sufficient basis to support upholding an allegedly discriminatory policy.
“There is often a ‘reasonable’ basis for discrimination, especially when government funds are involved,” Justice Gregory wrote.
Both states appealed separate lower court rulings that found denying gender-affirming care discriminatory and unconstitutional.Two three-judge panels from the Fourth Circuit heard arguments in both cases. last year before deciding to combine the two cases and submit them to the Grand Court.
In June 2022, north carolina court It required the state plan to pay for “medically necessary services” including hormone therapy and some surgeries for transgender employees and their children. A judge ruled in favor of employees and their dependents in a 2019 case who said they were denied gender-affirming care coverage under the plan.
North Carolina’s health plan provides health coverage to more than 750,000 teachers, state employees, retirees, legislators, and their dependents.
In August 2022, a federal judge ruled that West Virginia’s Medicaid program must provide gender-affirming care coverage for transgender residents.
Ann original lawsuit The 2020 submission was also named the State Employee Health Plan. A 2022 settlement with West Virginia Health Plan removed gender-affirming care exclusions in the company’s Public Employees Insurance Agency plans.
Lawyers in each state argued that treatments for gender dysphoria (North Carolina’s All Treatments and West Virginia’s Surgical Treatments) are excluded from insurance coverage for everyone, regardless of gender identity. . They argued that only some transgender people suffer from gender dysphoria, a diagnosis of distress over a gender identity that does not match their assigned gender.
Before suggesting any pharmaceutical or surgical intervention, Medical guidelines call for a thorough psychological evaluation To check for gender dysphoria before starting treatment.
Gregory said that in his view, gender dysphoria is “inextricably linked to virtually indistinguishable transgender status.”
“We hold that gender dysphoria, a diagnosis inseparable from transgender status, is a proxy for transgender identity,” the judges wrote. “And there are exemptions that prohibit treatment for gender dysphoria that prohibit treatment based on transgender identity by proxy.”
Unlike North Carolina, West Virginia has covered hormone therapy and other drug treatments for transgender people since 2017. Gregory noted that West Virginia’s program partially or fully covers genital mutilation and reconstructive surgery for diagnoses not related to gender dysphoria, such as cancer.
After the ruling, West Virginia plaintiff Shonte Anderson, a Black transgender woman and West Virginia Medicaid participant, said the state’s refusal to cover her care was “very dehumanizing. ” he said.
“I am very relieved to know that this court’s decision brings us one step closer to the day when Medicaid will no longer be able to deny transgender West Virginians access to the essential medical care their doctors need,” Anderson said in a statement. ” he said.
