Transgender Care Coverage Policies in West Virginia and North Carolina Discriminatory, Judges Say

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 Supreme Court the United States.

The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in the case involving the North Carolina State Employees’ Health Plan’s coverage of gender-affirming care and West Virginia Medicaid coverage of gender affirmation surgery.

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 “deeply dehumanizing.”

“I am so relieved that this court decision brings us 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.

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

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

During oral arguments in September, at least two justices said it was likely the case would eventually make its way to the U.S. Supreme Court. Both states appealed rulings from separate lower courts that found the denial of gender-affirming care discriminatory and unconstitutional. Two panels of three Fourth Circuit judges heard arguments in both cases last year before deciding to join the two cases and see them presented before a full court of 15 people.

In June 2022, a North Carolina trial court required the state plan to fund “medically necessary services,” including hormone therapy and certain surgical procedures, for transgender employees and their children. The judge had ruled in favor of the employees and their dependents, who said in a 2019 lawsuit that they had not been covered by the plan for gender-affirming care.

The North Carolina State Insurance Plan provides health coverage to more than 750,000 teachers, state employees, retirees, legislators and their dependents. While it provides counseling for diagnosed gender dysphoria and other mental health issues, it does not cover treatment “related to gender changes or modifications and associated care.”

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

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